{"hospital_name":"Providence Health And Services - Washington","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence St Mary Medical Center"],"hospital_address":["401 W Poplar St, Walla Walla, WA 99362"],"license_information":{"license_number":"HAC.FS.00000050","state":"WA"},"type_2_npi":["1386895886","1467603282"],"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":"Spencer Harris"},"financial_aid_policy":["30% 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":"Gatekeeper Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Non-Gatekeeper Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera - Lifewise Health Plan of Washington Affordable Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Heritage Signature All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence RealValue Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Uniform Other Commercial 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":"Community Health Plan","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Coordinated Care","plan_name":"Exchange","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":"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":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Moda","plan_name":"All Commercial Plans","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":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Providence Health Plan","plan_name":"Signature/Choice Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"HC SET PNEUMOTHORAX G03301","code_information":[{"code":"Px0000105784L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.6,"discounted_cash":594.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY CHEST PERC 28FR G04226","code_information":[{"code":"Px0000105884L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOSTATIC SURGICEL 4X8 1952","code_information":[{"code":"Px0000106035L","type":"CDM"}],"standard_charges":[{"gross_charge":592.99,"discounted_cash":415.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE ST .025 145CM G00617","code_information":[{"code":"Px0000112709L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON .035 145CM G00691","code_information":[{"code":"Px0000115848L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOP COAXIAL ACHIEVE 18X15","code_information":[{"code":"Px0000128518L","type":"CDM"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOP COAX ACHIEVE 14G 11CM CA1411","code_information":[{"code":"Px0000128898L","type":"CDM"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .035 180CM GR3508","code_information":[{"code":"Px0000128901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH FLEXIMA LOCKING-PIG 14FR M001271390","code_information":[{"code":"Px0000129370L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 6FR 23CM 401623M","code_information":[{"code":"Px0000132485L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE AMPLATZ SS ST .035 180CM M001465251","code_information":[{"code":"Px0000132748L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIL CRE ESOPH PYLORIC 18-20MM M00558500","code_information":[{"code":"Px0000138551L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH RAABE 6FR .038 55CM RB G11638","code_information":[{"code":"Px0000139082L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 8FR 23CM 401823M","code_information":[{"code":"Px0000139690L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH BRITE TIP 7FR 23CM 401723M","code_information":[{"code":"Px0000140220L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH FLEXOR RAABE RB 6F 70CM G11636","code_information":[{"code":"Px0000140328L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 7FR 10CM RSS704","code_information":[{"code":"Px0000140978L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 6F 10CM RSS602","code_information":[{"code":"Px0000144473L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 5F 10 CM RSS502","code_information":[{"code":"Px0000145003L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH GLIDE C2 4FR 65CM CG409","code_information":[{"code":"Px0000145947L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS PLEURA-SEAL AK01000","code_information":[{"code":"Px0000153464L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE WHISPER .014 190 CM 1005357H","code_information":[{"code":"Px0000155392L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE TFE 035 145CM COO G02356","code_information":[{"code":"Px0000156078L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.82,"discounted_cash":83.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSON 035 260CM BH","code_information":[{"code":"Px0000160281L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQUEST 8MM 4CM 75CM CQ7584","code_information":[{"code":"Px0000161061L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOP COAXIAL 14G X 15CM","code_information":[{"code":"Px0000206844L","type":"CDM"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRUSH CYTO CATH RX M00545000","code_information":[{"code":"Px0000216518L","type":"CDM"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":313.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOPINCE 18X15CM 360158001","code_information":[{"code":"Px0000216901L","type":"CDM"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOPINCE 18X20CM 360208001","code_information":[{"code":"Px0000216902L","type":"CDM"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE JAG .025/450 ST TIP M00556561","code_information":[{"code":"Px0000217333L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRO INTRODUCER 4.5FR/5FR 678950","code_information":[{"code":"Px0000217954L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PILOT 1010482H","code_information":[{"code":"Px0000218254L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH VISC 5FR 65CM .038 SIM1","code_information":[{"code":"Px0000218267L","type":"CDM"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 7X40MMX75CM CQ7574","code_information":[{"code":"Px0000219264L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PROWATER .014 180 AGH146000","code_information":[{"code":"Px0000219404L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SET RETRIEVAL GUNTHER TULIP G13287","code_information":[{"code":"Px0000220009L","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE LOC DUALOK 20GX77MM","code_information":[{"code":"Px0000221334L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE LOC DUALOK 20GX107MM","code_information":[{"code":"Px0000221335L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE BALANCE M/W UNIV 190CM 1009660","code_information":[{"code":"Px0000222154L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X38X80 85404","code_information":[{"code":"Px0000222540L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6430.0,"discounted_cash":4501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 7X59X80 85405","code_information":[{"code":"Px0000222541L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5722.0,"discounted_cash":4005.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH DESTINATION MP CC 6F RSR03","code_information":[{"code":"Px0000228072L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRACH VALVE PASSY MUIR PMV007","code_information":[{"code":"Px0000232900L","type":"CDM"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE CATH PACING 5FR 401770","code_information":[{"code":"Px0000233367L","type":"CDM"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH INTERNAL MAMMARY IM 5FR","code_information":[{"code":"Px0000235067L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH RENAL MP DEST 7F PINN P RSR04","code_information":[{"code":"Px0000236198L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":249.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH DRAINAGE 7.0P-5S CLDM-HC G11020","code_information":[{"code":"Px0000236218L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ 5X40MMX75CM CQ7554","code_information":[{"code":"Px0000236845L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE MAGIC TORQUE .035X180CM M001465911","code_information":[{"code":"Px0000238801L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SET PNEUMOTHORAX W/HEIMLICH","code_information":[{"code":"Px0000239747L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH ANGLED PIGTAIL 5FR 110CM","code_information":[{"code":"Px0000240764L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 4FR 10CM RSS402","code_information":[{"code":"Px0000240869L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL COAXIAL ADJ 20GX15CM ACT2015","code_information":[{"code":"Px0000244330L","type":"CDM"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL COAXIAL ADJ 20GX20CM ACT2020","code_information":[{"code":"Px0000244331L","type":"CDM"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRODUCER 7FR SHORT RSS701","code_information":[{"code":"Px0000246919L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IR BERENSTEIN II 4 FR 65CM 451415V0","code_information":[{"code":"Px0000247419L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG .038X150CM GR3806","code_information":[{"code":"Px0000249951L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINNACLE 8FR 10CM/0.38 RSS801","code_information":[{"code":"Px0000252899L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DELIVERY SYS BRAVO PH CAPSULE FGS0312","code_information":[{"code":"Px0000253123L","type":"CDM"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":643.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X38X80 85406","code_information":[{"code":"Px0000254048L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5943.0,"discounted_cash":4160.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT COVERED ICAST 8X59X80 85407","code_information":[{"code":"Px0000254049L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5722.0,"discounted_cash":4005.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL HANDPIECE SUROS 9GX12CM 20MM","code_information":[{"code":"Px0000255501L","type":"CDM"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC AMPL SUPSTI 035X75 M001465631","code_information":[{"code":"Px0000255599L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE PT GRAPHIX 300CM H7491491401J2","code_information":[{"code":"Px0000257828L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE MAGIC TRQ .035X260CM M001465921","code_information":[{"code":"Px0000259861L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUBE TRACH 8 CUFF DIST XL 80XLTCD","code_information":[{"code":"Px0000259996L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COIL/PLUG AMPLATZER 10MM/7MM 9PLUG010","code_information":[{"code":"Px0000261148L","type":"CDM"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":2737.0,"discounted_cash":1915.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X100MM X 120CM PRB3507100120","code_information":[{"code":"Px0000263509L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X150MM X 120CM PRB3507150120","code_information":[{"code":"Px0000263510L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1458.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PRONTO V3 EXTRACT 5003","code_information":[{"code":"Px0000263563L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN STERLING 5X10X135 H74939032501010","code_information":[{"code":"Px0000264014L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X100MM X 120CM PRB3506100120","code_information":[{"code":"Px0000266002L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X120MM X 120CM PRB3506120120","code_information":[{"code":"Px0000266003L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X150MM X 120CM PRB3506150120","code_information":[{"code":"Px0000266004L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1458.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X120MM X 120CM PRB3507120120","code_information":[{"code":"Px0000266005L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X100MM X 120CM PRB3508100120","code_information":[{"code":"Px0000266006L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X150MMX120CM PRB3508150120","code_information":[{"code":"Px0000266008L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1458.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HANDPIECE MR 20MM 3.7MM X 14CM ATEC091420MR","code_information":[{"code":"Px0000266039L","type":"CDM"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER LOC SET HNDPC 20MR ILS091420","code_information":[{"code":"Px0000266041L","type":"CDM"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL VIP 6F 610130","code_information":[{"code":"Px0000292099L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":545.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY PNEUMOTHORAX AK01500","code_information":[{"code":"Px0000292391L","type":"CDM"}],"standard_charges":[{"gross_charge":504.6,"discounted_cash":353.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUBE TRACH XLT CUFF DISTAL 7 70XLTCD","code_information":[{"code":"Px0000293629L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X40MM X 80CM PRB3508040080","code_information":[{"code":"Px0000295654L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMOB SHOULDER MALE MED 7984035","code_information":[{"code":"Px0000298566L","type":"CDM"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":548.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X40MM X 120CM PRB3506040120","code_information":[{"code":"Px0000299198L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X40MM X 120CM PRB3507040120","code_information":[{"code":"Px0000299199L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X60MM X 80CM PRB3508060080","code_information":[{"code":"Px0000299200L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 US 863017","code_information":[{"code":"Px0000299264L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X30MM X 120CM PRB3506030120","code_information":[{"code":"Px0000299886L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOP COAXIAL TEMNO EVOL 20X11CM","code_information":[{"code":"Px0000302529L","type":"CDM"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 5 X 320 SPD2US050320","code_information":[{"code":"Px0000302986L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.0,"discounted_cash":2345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 6 X 320 SPD2US060320","code_information":[{"code":"Px0000302988L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.0,"discounted_cash":2345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE EPD SPIDERFX .014 7 X 320 SPD2US070320","code_information":[{"code":"Px0000302990L","type":"CDM"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":3350.0,"discounted_cash":2345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH SOS OMNI 1 5FR 80CM","code_information":[{"code":"Px0000303234L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X80MMX120CM PRB3507080120","code_information":[{"code":"Px0000303669L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 6X60MMX120CM PRB3506060120","code_information":[{"code":"Px0000304049L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOP MRI ULTRACOR 14GSS","code_information":[{"code":"Px0000307078L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TISSUE ULTRACLIP2 COIL 864017","code_information":[{"code":"Px0000307940L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT MICROPUNCTURE TRANS NIT 4F","code_information":[{"code":"Px0000308428L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE BENTSN 035 145CM PBH TSFBP35145BH","code_information":[{"code":"Px0000308600L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROBE FIAPC 2.3MM 6.9FR 20132214","code_information":[{"code":"Px0000308688L","type":"CDM"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRSG VAC GRANUFM SIL SENSA MED M827509610","code_information":[{"code":"Px0000309575L","type":"CDM"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL CORE BIOP DEVICE CELERO12","code_information":[{"code":"Px0000309593L","type":"CDM"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":550.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLIP SECURMARK","code_information":[{"code":"Px0000309595L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROBE FIAPC 2.3MM CIRCUMFERENC 20132218","code_information":[{"code":"Px0000309706L","type":"CDM"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WIRE BMW II UNIV 190CM 1009664","code_information":[{"code":"Px0000311097L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 45CM 407645","code_information":[{"code":"Px0000311398L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD ATR/VENT BIPLR 5.7FR 52CM 407652","code_information":[{"code":"Px0000311399L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH INTRO GUIDEWIRE 6FR RSS601","code_information":[{"code":"Px0000311588L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO FL4 5F 16391-22","code_information":[{"code":"Px0000311801L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRODUCER KIT G48007","code_information":[{"code":"Px0000313768L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FEM COMPRESSION WITH MANOMETER C11165","code_information":[{"code":"Px0000314807L","type":"CDM"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE MARKER WING ULTRACLP II 862017D","code_information":[{"code":"Px0000314848L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT NEPHROSTOMY W/GLIDEX 8FR","code_information":[{"code":"Px0000315501L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH 6FR MPA2","code_information":[{"code":"Px0000315820L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL COAXIAL BIOP BLUE 16GX15CM","code_information":[{"code":"Px0000316264L","type":"CDM"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH PINN 5FR 10CM .035 RSS501","code_information":[{"code":"Px0000316631L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH ANGIO FL3.5 5F 16391-21","code_information":[{"code":"Px0000318489L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOSEAL EVOLUTION 6FR C610134","code_information":[{"code":"Px0000324961L","type":"CDM"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":545.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.0 X 12 H7493895912200","code_information":[{"code":"Px0000330678L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.25 X 12 H7493895912220","code_information":[{"code":"Px0000330679L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.5 X 12 H7493895912250","code_information":[{"code":"Px0000330680L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.0 X 12 H7493895912300","code_information":[{"code":"Px0000330682L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 1.5 X 15 FLEX","code_information":[{"code":"Px0000330689L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.0 X 15 H7493895915200","code_information":[{"code":"Px0000330690L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.5 X 15 H7493895915250","code_information":[{"code":"Px0000330692L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.0 X 15 H7493895915300","code_information":[{"code":"Px0000330694L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 2.5 X 20 H7493895920250","code_information":[{"code":"Px0000330704L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.0 X 20","code_information":[{"code":"Px0000330706L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.5 X 20","code_information":[{"code":"Px0000330708L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN APEX RX 3.0 X 30","code_information":[{"code":"Px0000330717L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH EXPO 5F SELECTIVE WRP H74908526512","code_information":[{"code":"Px0000331215L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARCTIC SUN COOLING PAD MED 3170702","code_information":[{"code":"Px0000334295L","type":"CDM"}],"standard_charges":[{"gross_charge":3192.0,"discounted_cash":2234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARTIC SUN COOLING PAD LG 3170902","code_information":[{"code":"Px0000334296L","type":"CDM"}],"standard_charges":[{"gross_charge":3192.0,"discounted_cash":2234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH TEMPO AQUA H1 SRD6107","code_information":[{"code":"Px0000335156L","type":"CDM"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH RESOLVE LKG DRAINAGE 12FR","code_information":[{"code":"Px0000338057L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X40MMX80CM PRB3507040080","code_information":[{"code":"Px0000342686L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X60MMX120CM PRB3507060120","code_information":[{"code":"Px0000342687L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X40MMX120CM PRB3508040120","code_information":[{"code":"Px0000343000L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X60MMX120CM PRB3508060120","code_information":[{"code":"Px0000343001L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN DORADO 10X40MMX80CM DR80104","code_information":[{"code":"Px0000343689L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN DORADO 6X4X80 DR8064","code_information":[{"code":"Px0000343693L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN DORADO 7X40MMX80CM DR8074","code_information":[{"code":"Px0000343695L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN DORADO 9X4X80 DR8094","code_information":[{"code":"Px0000343699L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X120MMX150CM AB14W025120150","code_information":[{"code":"Px0000347400L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE ASHAI XT .014 300CM AGP140302","code_information":[{"code":"Px0000348119L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X100MMX135CM AB35W05100135","code_information":[{"code":"Px0000348129L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACE LT WRIST COCKUP L3908","code_information":[{"code":"Px0000348988L","type":"CDM"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOPSY EVIVA APERTURE 20MM EVIVA091320","code_information":[{"code":"Px0000349449L","type":"CDM"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOPSY SITE 1ST SMARKEVIVA13","code_information":[{"code":"Px0000349450L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOP SECURMARK EVIVA 2 SMARKEVIVA2S13","code_information":[{"code":"Px0000349452L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH RESOLVE LKG DRAINAGE 8FR","code_information":[{"code":"Px0000350242L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT WALLFLEX BIL RX UC 10X40 M00570890","code_information":[{"code":"Px0000350354L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4360.0,"discounted_cash":3052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT DILATOR VASCULAR 200120","code_information":[{"code":"Px0000350521L","type":"CDM"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":541.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BX TRIMARK HRGLASS 130MM TRIMARKEVIVA2S13","code_information":[{"code":"Px0000351096L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH DRAIN MULTIPURPOSE 10.2FR G10050","code_information":[{"code":"Px0000352958L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 8X30MMX80CM PRB3508030080","code_information":[{"code":"Px0000354058L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN COYTE OTW3.0X40MMX145 H74939134304010","code_information":[{"code":"Px0000354194L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ULTRACLIP BARD TRIGGER RIBBON 17G 863017D","code_information":[{"code":"Px0000354970L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT TUBE FEED JEJU 12FR 0200-12LV 020012LV","code_information":[{"code":"Px0000355888L","type":"CDM"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 180CM GA3501","code_information":[{"code":"Px0000355901L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACE LSO MEDIUM","code_information":[{"code":"Px0000355903L","type":"CDM"},{"code":"L0631","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACE LSO LARGE","code_information":[{"code":"Px0000355904L","type":"CDM"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACE LSO SM","code_information":[{"code":"Px0000356502L","type":"CDM"},{"code":"L0631","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 6F 2088TC46","code_information":[{"code":"Px0000356894L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BAND TR LONG 29CM TRB29LRG","code_information":[{"code":"Px0000357185L","type":"CDM"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .035 X 90CM SC035090","code_information":[{"code":"Px0000357190L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH TRAILBLAZER .035 X 135CM SC035135","code_information":[{"code":"Px0000357191L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIDEWIRE ANG ADV .035 X 260CM GA3502","code_information":[{"code":"Px0000357228L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":548.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH GUIDELINER 6F 20/135CM 5571","code_information":[{"code":"Px0000358350L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE RUNTHRU .014X180X3 251011","code_information":[{"code":"Px0000360570L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 8 H7493912408250","code_information":[{"code":"Px0000361836L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 8 H7493912408300","code_information":[{"code":"Px0000361838L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 8 H7493912408320","code_information":[{"code":"Px0000361839L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 8 H7493912408350","code_information":[{"code":"Px0000361840L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.75 X 8 H7493912408370","code_information":[{"code":"Px0000361841L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 8 H7493912408400","code_information":[{"code":"Px0000361842L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.50 X 8 H7493912408450","code_information":[{"code":"Px0000361843L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 12 H7493912412250","code_information":[{"code":"Px0000361847L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 12 H7493912412300","code_information":[{"code":"Px0000361849L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.25 X 12 H7493912412320","code_information":[{"code":"Px0000361850L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 12 H7493912412350","code_information":[{"code":"Px0000361851L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.0 X 12 H7493912412400","code_information":[{"code":"Px0000361853L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 4.50 X 12 H7493912412450","code_information":[{"code":"Px0000361854L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 5.0 X 12 H7493912412500","code_information":[{"code":"Px0000361855L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.50 X 15 H7493912415350","code_information":[{"code":"Px0000361862L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 2.50 X 20 H7493912420250","code_information":[{"code":"Px0000361869L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM RX 3.0 X 20 H7493912420300","code_information":[{"code":"Px0000361871L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NC QUANTUM 4.0 X 20 H7493912420400","code_information":[{"code":"Px0000361875L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOCROSS 2.5X210MMX150CM AB14W025210150","code_information":[{"code":"Px0000364288L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X210MMX150CM AB14W030210150","code_information":[{"code":"Px0000364289L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT EVERFLEX 7X60MMX80CM PRB3507060080","code_information":[{"code":"Px0000365165L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 3.0X4X135 AB35W03040135","code_information":[{"code":"Px0000365454L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 4.0X3X135","code_information":[{"code":"Px0000365455L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X40MMX135CM AB35W04040135","code_information":[{"code":"Px0000365456L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X60MMX135CM AB35W04060135","code_information":[{"code":"Px0000365457L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 5.0X3X135 AB35W05030135","code_information":[{"code":"Px0000365458L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 6.0X3X135 AB35W06030135","code_information":[{"code":"Px0000365461L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X40MMX135CM AB35W06040135","code_information":[{"code":"Px0000365462L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X60MMX135CM AB35W06060135","code_information":[{"code":"Px0000365463L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 6.0X8X135 AB35W06080135","code_information":[{"code":"Px0000365464L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X100MMX135CM AB35W06100135","code_information":[{"code":"Px0000365465L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN PTA EVERCROSS 7.0X3X135 AB35W07030135","code_information":[{"code":"Px0000365467L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 7X40MMX135CM AB35W07040135","code_information":[{"code":"Px0000365468L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X30MMX135CM AB35W08030135","code_information":[{"code":"Px0000365474L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X40MMX135CM AB35W08040135","code_information":[{"code":"Px0000365475L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 8X60MMX135CM AB35W08060135","code_information":[{"code":"Px0000365476L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X80MMX80CM AB35W05080080","code_information":[{"code":"Px0000365481L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEART TRAIL 3 6FR IR 1.0 406380","code_information":[{"code":"Px0000366153L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VISI-PRO 10X27MMX80CM PXB351027080","code_information":[{"code":"Px0000366298L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHEATH 5FR RADIAL","code_information":[{"code":"Px0000367186L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACCESS KIT SCREEN SNAP LID SCS 355531","code_information":[{"code":"Px0000367889L","type":"CDM"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN SPRINTER LEGEND RX 1.25X15 SPL12515X","code_information":[{"code":"Px0000370629L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X210MMX150CM AB14W020210150","code_information":[{"code":"Px0000370695L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSXC","code_information":[{"code":"Px0000372995L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":7956.0,"discounted_cash":5569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH TURBOHAWK THSSSC","code_information":[{"code":"Px0000372996L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":7956.0,"discounted_cash":5569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT CATH EQSTRM 16FR 27CM ST 5913270","code_information":[{"code":"Px0000373007L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH MUSTANG 3MMX40MMX75CM H74939171030470","code_information":[{"code":"Px0000373467L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH MUSTANG 4MMX20MMX75CM H74939171040270","code_information":[{"code":"Px0000373475L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 4X40MMX75CM H74939171040470","code_information":[{"code":"Px0000373477L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH MUSTANG 5MMX40MMX75CM H74939171050470","code_information":[{"code":"Px0000373487L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 6X40MMX75CM H74939171060470","code_information":[{"code":"Px0000373497L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 7X40MMX75CM H74939171070470","code_information":[{"code":"Px0000373507L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 10X40MMX75CM H74939171100470","code_information":[{"code":"Px0000373532L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 6X60MMX135CM H74939171060610","code_information":[{"code":"Px0000373573L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH MUSTANG 6MMX200MMX135CM H74939171062010","code_information":[{"code":"Px0000373579L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EXTRACTOR RETREVL 9-12 M00547000","code_information":[{"code":"Px0000373972L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.0,"discounted_cash":441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EXTRACT RETRV 12-15 M00547010","code_information":[{"code":"Px0000373973L","type":"CDM"}],"standard_charges":[{"gross_charge":631.0,"discounted_cash":441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH MUSTANG 5MMX80MMX75CM H74939171050870","code_information":[{"code":"Px0000373976L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X80MMX150CM AB14W020080150","code_information":[{"code":"Px0000374269L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 10ML 9390110","code_information":[{"code":"Px0000375923L","type":"CDM"}],"standard_charges":[{"gross_charge":27.82,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 20ML 9390120","code_information":[{"code":"Px0000375924L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +10 50ML 9390150","code_information":[{"code":"Px0000375927L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BIOP ONCNTRL STY TY 102MM 9408VC006","code_information":[{"code":"Px0000376100L","type":"CDM"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY BIOPSY ONCONTROL 152MM 9411VC006","code_information":[{"code":"Px0000376101L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SET THRMB SOLENT OMNI 109681001","code_information":[{"code":"Px0000376223L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4831.0,"discounted_cash":3381.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X120MMX135CM AB35W05120135","code_information":[{"code":"Px0000378962L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FILTER IVC GUNTHER TULIP J F G52918","code_information":[{"code":"Px0000382140L","type":"CDM"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":2015.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 6X37MMX135CM PXB350637135","code_information":[{"code":"Px0000384073L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 7X27MMX135CM PXB350727135","code_information":[{"code":"Px0000384076L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 7X37MMX135CM PXB350737135","code_information":[{"code":"Px0000384077L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 8X27MMX135CM PXB350827135","code_information":[{"code":"Px0000384079L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 8X57MMX135CM PXB350857135","code_information":[{"code":"Px0000384081L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 10X40MMX135CM AB35W10040135","code_information":[{"code":"Px0000384082L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 10X60MMX135CM","code_information":[{"code":"Px0000384083L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 12X40MMX135CM AB35W12040135","code_information":[{"code":"Px0000384084L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 52CM 2088TC52","code_information":[{"code":"Px0000385358L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL PACING STS 58CM 2088TC58","code_information":[{"code":"Px0000385359L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 9X30MMX120CM SERB650930120","code_information":[{"code":"Px0000386385L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 10X40MMX120CM SERB651040120","code_information":[{"code":"Px0000386391L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 10X80MMX120CM SERB651080120","code_information":[{"code":"Px0000386393L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 12X60MMX120 SERB651260120","code_information":[{"code":"Px0000386397L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 12X80MMX120CM SERB651280120","code_information":[{"code":"Px0000386398L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 14X40MMX120 SERB651440120","code_information":[{"code":"Px0000386401L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 6FR 14X60MMX120 SERB651460120","code_information":[{"code":"Px0000386402L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI PRTG 14X80MMX120CM SERB651480120","code_information":[{"code":"Px0000386403L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT BILI VS-PRO 10X37MM X 135 PXB351037135","code_information":[{"code":"Px0000386436L","type":"CDM"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 3X120MMX135CM AB35W03120135","code_information":[{"code":"Px0000386465L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 4X100MMX135CM AB35W04100135","code_information":[{"code":"Px0000386475L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X40MMX135CM AB35W05040135","code_information":[{"code":"Px0000386483L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X60MMX135CM AB35W05060135","code_information":[{"code":"Px0000386485L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 5X120MMX80CM AB35W05120080","code_information":[{"code":"Px0000386489L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 6X80MMX80CM AB35W06080080","code_information":[{"code":"Px0000386496L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN EVERX 9X40MMX135CM AB35W09040135","code_information":[{"code":"Px0000386512L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X120MMX150CM AB14W020120150","code_information":[{"code":"Px0000386531L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.0X40MMX150CM AB14W020040150","code_information":[{"code":"Px0000386535L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X40MMX150CM AB14W025040150","code_information":[{"code":"Px0000386539L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 2.5X80MMX150CM AB14W025080150","code_information":[{"code":"Px0000386541L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X120MMX150CM AB14W030120150","code_information":[{"code":"Px0000386543L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X40MMX150CM AB14W030040150","code_information":[{"code":"Px0000386547L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 3.0X80MMX150CM AB14W030080150","code_information":[{"code":"Px0000386549L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X120MMX150CM AB14W040120150","code_information":[{"code":"Px0000386557L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X40MMX150CM AB14W040040150","code_information":[{"code":"Px0000386561L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN NANOX 4.0X80MMX150CM AB14W040080150","code_information":[{"code":"Px0000386563L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HANDPIECE EVIVA 9G X 13CM 12MM EVIVA091312T","code_information":[{"code":"Px0000387036L","type":"CDM"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLIP SECURMARK FOR CELERO 2S","code_information":[{"code":"Px0000390362L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN BAKRI POSTPARTUM RAPID G24237 CDM","code_information":[{"code":"Px0000392702L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":822.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH STENT GRFT BLN Q50 PUS","code_information":[{"code":"Px0000393364L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1594.0,"discounted_cash":1115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG SL 4FR 1194108","code_information":[{"code":"Px0000393752L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":572.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG DL 5FR FULL 1295108","code_information":[{"code":"Px0000393753L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":605.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD CV SPRINT QUAT S DF4 62CM 6935M62","code_information":[{"code":"Px0000395024L","type":"CDM"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":6314.0,"discounted_cash":4419.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRSG VAC VERAFLO MED ULTVFL05MD","code_information":[{"code":"Px0000397886L","type":"CDM"},{"code":"A6550","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CHOC PTA .018 5X120 CB1812050120OTW","code_information":[{"code":"Px0000398107L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1957.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CHOC PTA .018 6X120X120 CB1812060120OTW","code_information":[{"code":"Px0000398110L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1957.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IMPULSE ANG 5FX100CM MPA1","code_information":[{"code":"Px0000401358L","type":"CDM"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN MUSTNG 6.0X60MMX75CM H74939171060670","code_information":[{"code":"Px0000401427L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN MUSTNG 7.0X60MMX75CM H74939171070670","code_information":[{"code":"Px0000401428L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE HT ES COMMAND.014 300CM 2078175","code_information":[{"code":"Px0000409683L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 2.5X10MM 22002510","code_information":[{"code":"Px0000413219L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.5X10MM 22003510","code_information":[{"code":"Px0000413221L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.0X15MM 22003015","code_information":[{"code":"Px0000413227L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN SCORING RX 3.5X15MM 22003515","code_information":[{"code":"Px0000413229L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN MINI TREK II OTW 2.0X15MM 101240315A","code_information":[{"code":"Px0000419046L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ40 6X40MMX75CM","code_information":[{"code":"Px0000424468L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ40 7X40MMX75CM","code_information":[{"code":"Px0000424469L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLN CONQ40 8X40MMX75CM CQF7584","code_information":[{"code":"Px0000424470L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC WHLY STD 35X175","code_information":[{"code":"Px0000428837L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ICD-DELLIPSE DR 36 NX GEN CD241136C","code_information":[{"code":"Px0000431611L","type":"CDM"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":18283.0,"discounted_cash":12798.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ICD-D FORT ASSURA VR DF4 NXGEN CD135740Q","code_information":[{"code":"Px0000431614L","type":"CDM"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":15155.0,"discounted_cash":10608.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PLNDRMP PK V/T 14.5/19","code_information":[{"code":"Px0000432415L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":946.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PLNDRM P PL V/T 14.5/23","code_information":[{"code":"Px0000432416L","type":"CDM"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":946.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR 3CG TL 6FR FULL 1396108","code_information":[{"code":"Px0000434273L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.0,"discounted_cash":671.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IVUS RADIAL OPTICROSS H749518110","code_information":[{"code":"Px0000440045L","type":"CDM"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":2188.0,"discounted_cash":1531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE VASC WHLY STD 260CM","code_information":[{"code":"Px0000447014L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PREP F/SAVI DEVI","code_information":[{"code":"Px0000447773L","type":"CDM"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":534.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TRIAL COMPACT 1X8 977D260","code_information":[{"code":"Px0000448230L","type":"CDM"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER REVEA LNQ11","code_information":[{"code":"Px0000454083L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":11385.0,"discounted_cash":7969.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY SAVI-08 GAMMA APPLCATR SAVI08GAMMA","code_information":[{"code":"Px0000454751L","type":"CDM"},{"code":"C1728","type":"HCPCS"}],"standard_charges":[{"gross_charge":6302.0,"discounted_cash":4411.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GWIRE MAILMAIN 182CM","code_information":[{"code":"Px0000456731L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 6X5X120CM VBHR060502A","code_information":[{"code":"Px0000458363L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7513.0,"discounted_cash":5259.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X5X120CM VBHR070502A","code_information":[{"code":"Px0000458372L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7508.0,"discounted_cash":5255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 7X10X120CM VBHR071002A","code_information":[{"code":"Px0000458374L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8516.0,"discounted_cash":5961.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VIABAHN A HEP 8X5X120CM VBHR080502A","code_information":[{"code":"Px0000458381L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7508.0,"discounted_cash":5255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUBE FEED TG M-KEY 22FX2.0X45 0270222045","code_information":[{"code":"Px0000458952L","type":"CDM"}],"standard_charges":[{"gross_charge":1280.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT DES ALPINE 3.00X18 RX 112530018","code_information":[{"code":"Px0000459245L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1873.0,"discounted_cash":1311.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IAB SENS PLS 8FR 50CC 068400057601U","code_information":[{"code":"Px0000461662L","type":"CDM"}],"standard_charges":[{"gross_charge":3033.0,"discounted_cash":2123.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH GDE CONVEY 5FR JL3","code_information":[{"code":"Px0000462777L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACTA CREAM 10ML CALORIC FORTIFIER","code_information":[{"code":"Px0000463588L","type":"CDM"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INST BIOP CORE MISSION 20G 16CM 2016MSK","code_information":[{"code":"Px0000463604L","type":"CDM"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X40MMX130CM ADM04004013P","code_information":[{"code":"Px0000465009L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X60MMX130CM ADM04006013P","code_information":[{"code":"Px0000465011L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X80MMX130CM ADM04008013P","code_information":[{"code":"Px0000465013L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X120MMX130CM ADM04012013P","code_information":[{"code":"Px0000465015L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X40MMX130CM ADM05004013P","code_information":[{"code":"Px0000465017L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X40MMX130CM ADM06004013P","code_information":[{"code":"Px0000465025L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRT-D DYNAGEN DF4","code_information":[{"code":"Px0000484778L","type":"CDM"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":24478.0,"discounted_cash":17134.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY BIOPSY COMP ONCTRL 152MM 9451VC006","code_information":[{"code":"Px0000515856L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY BIOP COMP ONCTRL 9458VC006","code_information":[{"code":"Px0000536440L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PERIPH HAWKONE H1LS","code_information":[{"code":"Px0000546902L","type":"CDM"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":8271.0,"discounted_cash":5789.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY APPLIC SAVI 6-1MINI GAMMA","code_information":[{"code":"Px0000548009L","type":"CDM"},{"code":"C1728","type":"HCPCS"}],"standard_charges":[{"gross_charge":6302.0,"discounted_cash":4411.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAY APPLIC SAVI 10-1 GAMMA SAVI10GAMMA","code_information":[{"code":"Px0000548011L","type":"CDM"},{"code":"C1728","type":"HCPCS"}],"standard_charges":[{"gross_charge":6302.0,"discounted_cash":4411.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIDESHEATH SLENDER 6FR 601065","code_information":[{"code":"Px0000591044L","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD IPG TRIAL NEVRO 50CM TLEAD105850B","code_information":[{"code":"Px0000593069L","type":"CDM"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD IPG TRIAL NEVRO 70CM TLEAD105870B","code_information":[{"code":"Px0000593070L","type":"CDM"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL W/ 0.40X10MM GOLD ANCHOR MRKR 0.7X200M","code_information":[{"code":"Px0000594215L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL W/ 0.40X20MM GOLD ANCHOR MRKR 0.7X200M","code_information":[{"code":"Px0000594216L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IV ACCUCATH 18G 2.25 AC0182250","code_information":[{"code":"Px0000608818L","type":"CDM"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GUIDEWIRE PRESS COMET 185CM H7495551110","code_information":[{"code":"Px0000610506L","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2188.0,"discounted_cash":1531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE DR EL MRI L331","code_information":[{"code":"Px0000611409L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":5548.0,"discounted_cash":3883.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACEMAKER ACCOLADE VR MRI L310","code_information":[{"code":"Px0000611411L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 45 CM 7740","code_information":[{"code":"Px0000611416L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 52 CM 7741","code_information":[{"code":"Px0000611417L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD PACER ACTV FIX STR 59CM 7742","code_information":[{"code":"Px0000611418L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IV ACCUCATH 20G 1.25","code_information":[{"code":"Px0000613237L","type":"CDM"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH IV ACCUCATH 20G 2.25 AC0202250","code_information":[{"code":"Px0000613240L","type":"CDM"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 28 100ML 95028100","code_information":[{"code":"Px0000616190L","type":"CDM"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH ADVANCE ASPIR EXPORT","code_information":[{"code":"Px0000620847L","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":919.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD STIM SURESCAN MRI 65CM 977C165","code_information":[{"code":"Px0000622276L","type":"CDM"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10879.0,"discounted_cash":7615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TISS BRST ULTCOR 17G UCTW17","code_information":[{"code":"Px0000622671L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH CV POWER POLY MDL SL 4FR P4154108D","code_information":[{"code":"Px0000623259L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":405.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INST CORE BIOP MARQUEE DSP 16G","code_information":[{"code":"Px0000625021L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT MARQUEE W/COAX 14GAX10CM","code_information":[{"code":"Px0000638781L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 4X150MMX130CM ADM04015013P","code_information":[{"code":"Px0000643204L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 5X150MMX130CM ADM05015013P","code_information":[{"code":"Px0000643205L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN ADM 6X150MMX130CM ADM06015013P","code_information":[{"code":"Px0000643206L","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACER ASSURITY MRI DR RF PM2272","code_information":[{"code":"Px0000643575L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.0,"discounted_cash":3886.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACER ASSURITY MRI SR RF PM1272","code_information":[{"code":"Px0000643576L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":4672.0,"discounted_cash":3270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 46CM LPA1200M46","code_information":[{"code":"Px0000643579L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 52CM LPA1200M52","code_information":[{"code":"Px0000643580L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD TENDRIL MRI 58CM LPA1200M58","code_information":[{"code":"Px0000643581L","type":"CDM"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH GDE EXT GUIDEZILLA II 6F H7493933515060","code_information":[{"code":"Px0000647603L","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1466.0,"discounted_cash":1026.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUMARK VISION 10CM","code_information":[{"code":"Px0000660352L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL CATH DRAIN SET 8.3FR 18GA","code_information":[{"code":"Px0000662289L","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUMARK PROF X SHP 10CM","code_information":[{"code":"Px0000663883L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LOOP RECORDER CONFIRM RX DM3500","code_information":[{"code":"Px0000664060L","type":"CDM"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":8929.0,"discounted_cash":6250.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEUROSTIM EXTR WRLSS N-RECHG 97725","code_information":[{"code":"Px0000664412L","type":"CDM"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 5CM SSR0501","code_information":[{"code":"Px0000664459L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1207.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 7.5CM SSR7501","code_information":[{"code":"Px0000664460L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1207.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REFLECTOR MARKER SAVI SCOUT 10CM SSR1001","code_information":[{"code":"Px0000664461L","type":"CDM"},{"code":"C1739","type":"HCPCS"}],"standard_charges":[{"gross_charge":1725.0,"discounted_cash":1207.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT FULL PG PRO 20G 8CM","code_information":[{"code":"Px0000664701L","type":"CDM"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT FULL PG PRO 20G 10CM","code_information":[{"code":"Px0000664702L","type":"CDM"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT FULL PG PRO 18G 8CM F118081","code_information":[{"code":"Px0000664703L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT FULL PG PRO 18G 10CM F118101","code_information":[{"code":"Px0000664704L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 3.00MMX38MM 155030038","code_information":[{"code":"Px0000675080L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1873.0,"discounted_cash":1311.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT CRNRY XIENCE 4.00MMX38MM 155040038","code_information":[{"code":"Px0000675104L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":1766.0,"discounted_cash":1236.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 4.0X60 75CM H74939171040670","code_information":[{"code":"Px0000676881L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN MUSTNG 5.0X60 75CM","code_information":[{"code":"Px0000676882L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH BLN STRLG OTW 5X100MMX135","code_information":[{"code":"Px0000677213L","type":"CDM"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL CMPLX STD 36MMX60CM RBY2C3660","code_information":[{"code":"Px0000679384L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":4025.0,"discounted_cash":2817.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COIL EMBL CMPLX STD 40MMX60CM RBY2C4060","code_information":[{"code":"Px0000679385L","type":"CDM"},{"code":"L8699","type":"HCPCS"}],"standard_charges":[{"gross_charge":4025.0,"discounted_cash":2817.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEV BIOP COAX BLNT 18GX10 LOK","code_information":[{"code":"Px0000700946L","type":"CDM"}],"standard_charges":[{"gross_charge":303.15,"discounted_cash":212.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEV BIOP COAX BLNT 18GX15 LOK","code_information":[{"code":"Px0000700948L","type":"CDM"}],"standard_charges":[{"gross_charge":303.15,"discounted_cash":212.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEV BIOP COAX BLNT 18GX20 LOK","code_information":[{"code":"Px0000700950L","type":"CDM"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACER AZURE XT SR MRI W1SR01","code_information":[{"code":"Px0000711378L","type":"CDM"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":4569.0,"discounted_cash":3198.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACER AZURE XT DR MRI W1DR01","code_information":[{"code":"Px0000711379L","type":"CDM"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":5274.0,"discounted_cash":3691.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT BIOP MARQUEE 16CM 16GA","code_information":[{"code":"Px0000712646L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT BIOP 10CM 18GA MQK1810","code_information":[{"code":"Px0000712647L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT BIOP 16CM 18GA MQK1816","code_information":[{"code":"Px0000712648L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT INST CORE BIOP MARQ 14GX16","code_information":[{"code":"Px0000717479L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT INST CORE BIOP MARQ 18GX20 MQK1820","code_information":[{"code":"Px0000717481L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT INST CORE BIOP MARQ 18GX25","code_information":[{"code":"Px0000717482L","type":"CDM"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BRST TISS COIL 14GX13CM","code_information":[{"code":"Px0000717506L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER BRST TISS RIB 14GX13CM","code_information":[{"code":"Px0000717508L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 15ML 9390115","code_information":[{"code":"Px0000717862L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROBE ELEV BRST BIOPSY SYS EV12","code_information":[{"code":"Px0000761774L","type":"CDM"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUBE FEED JEJU ENFIT CONN 14FR 820014","code_information":[{"code":"Px0000774964L","type":"CDM"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT VBAHN HEP 10MMX5CM 8F VBHR100502A","code_information":[{"code":"Px0000776667L","type":"CDM"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7508.0,"discounted_cash":5255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL BREVERA 9G 20MM 13CM BREVDISP09","code_information":[{"code":"Px0000776934L","type":"CDM"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":9288.0,"discounted_cash":6501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP","code_information":[{"code":"Px0000827254L","type":"CDM"}],"standard_charges":[{"gross_charge":1978.0,"discounted_cash":1384.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELCTRD HEADBAND EEG CERIBELL DISP NTAP PEDIATR","code_information":[{"code":"Px0000827255L","type":"CDM"}],"standard_charges":[{"gross_charge":1978.0,"discounted_cash":1384.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROBE BRST BIOP MULT SMPL 14GA EV14","code_information":[{"code":"Px0000872243L","type":"CDM"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TUMARK PROF Q SHP","code_information":[{"code":"Px0000873682L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TUMARK VSN PETITE TUMARKBREVPVISION","code_information":[{"code":"Px0000873683L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TUMARK STD PROF Q SHP TUMARK-BREV-S-Q","code_information":[{"code":"Px0000873685L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MARKER TUMARK VSN STD TUMARKBREVSVISION","code_information":[{"code":"Px0000873686L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MATRIX HEMOSTATIC WITH RECOTHROM FLOSEAL 5ML ADS202105","code_information":[{"code":"Px0001001561L","type":"CDM"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUMARK CONIC 18G X 10CM 351260","code_information":[{"code":"Px0001002149L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT DEV INTRAUTERINE HEMORRHAGE JADA 1047196 CDM","code_information":[{"code":"Px0001007757L","type":"CDM"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 24 100ML 95024100","code_information":[{"code":"Px0001012655L","type":"CDM"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1115 11GAX15CM","code_information":[{"code":"Px0001061586L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":462.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT BIOPSY BONE MARROW NDL TREK TKM1110 11GAX10CM","code_information":[{"code":"Px0001061593L","type":"CDM"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":462.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COIL EMBOLIZATION NON COATED DETACHABLE OPTIBLOCK OPTI0635BLK 6X35MM","code_information":[{"code":"Px0001061596L","type":"CDM"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10049.0,"discounted_cash":7034.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT NEEDLE INSERTION NEUROSTIMULATOR PAIN MANAGEMENT EPMD1060 14GAX6IN","code_information":[{"code":"Px0001096199L","type":"CDM"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OVERFLOW","code_information":[{"code":"Px00012010003","type":"CDM"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":3733.0,"discounted_cash":2613.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ISOLATION","code_information":[{"code":"Px00012010011","type":"CDM"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB","code_information":[{"code":"Px00012210001","type":"CDM"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE OB HIGH RISK","code_information":[{"code":"Px00012210003","type":"CDM"}],"standard_charges":[{"gross_charge":2965.0,"discounted_cash":2075.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE PSYCHIATRIC","code_information":[{"code":"Px00012410001","type":"CDM"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ONCOLOGY","code_information":[{"code":"Px00012710001","type":"CDM"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":2934.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE REHAB","code_information":[{"code":"Px00012810001","type":"CDM"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1568.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM IP REHAB (32564400)"},{"gross_charge":2240.0,"discounted_cash":1568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY ROUTINE CARE","code_information":[{"code":"Px00017010001","type":"CDM"}],"standard_charges":[{"gross_charge":3000.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 2","code_information":[{"code":"Px00017210001","type":"CDM"}],"standard_charges":[{"gross_charge":9250.0,"discounted_cash":6475.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B NURSERY/LEVEL 3","code_information":[{"code":"Px00017310001","type":"CDM"}],"standard_charges":[{"gross_charge":12950.0,"discounted_cash":9065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS WA CDM","code_information":[{"code":"Px00019110002","type":"CDM"}],"standard_charges":[{"gross_charge":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE","code_information":[{"code":"Px00020010001","type":"CDM"}],"standard_charges":[{"gross_charge":8647.0,"discounted_cash":6052.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-ICU ISOLATION","code_information":[{"code":"Px00020010011","type":"CDM"}],"standard_charges":[{"gross_charge":8647.0,"discounted_cash":6052.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE","code_information":[{"code":"Px00020610001","type":"CDM"}],"standard_charges":[{"gross_charge":3733.0,"discounted_cash":2613.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC R&B-INTERMEDIATE/TELEMETRY ISOLATION","code_information":[{"code":"Px00020610003","type":"CDM"}],"standard_charges":[{"gross_charge":6647.0,"discounted_cash":4652.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00026010004","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":5172.0,"discounted_cash":3620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":553.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4770.0,"discounted_cash":3339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COVID PPE WA STATE ONLY SBR 5169","code_information":[{"code":"Px00027000011","type":"CDM"},{"code":"99072","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":4.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OT EO  W/ JOINTS  CUSTOM","code_information":[{"code":"Px00027410136","type":"CDM"},{"code":"L3730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":774.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLEX GLOVE W/ELASTIC FINGER","code_information":[{"code":"Px00027410170","type":"CDM"},{"code":"L3912","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SEWHO CAP DESIGN W/O JNTS CF","code_information":[{"code":"Px00027410171","type":"CDM"},{"code":"L3961","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.0,"discounted_cash":1201.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WHFO NONTORSION JOINT PREFAB","code_information":[{"code":"Px00027410173","type":"CDM"},{"code":"L3931","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUFFS ADJ LOCK W/ ACTIVE CON","code_information":[{"code":"Px00027410182","type":"CDM"},{"code":"L3740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.0,"discounted_cash":790.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELBOW-HINGED SPLINT PER VISIT","code_information":[{"code":"Px00027410183","type":"CDM"},{"code":"L3982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":725.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EO DBL UPRIGHT W/STOPS CF","code_information":[{"code":"Px00027410184","type":"CDM"},{"code":"L3740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.0,"discounted_cash":790.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EWHF W/JOINT CF","code_information":[{"code":"Px00027410185","type":"CDM"},{"code":"L3766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FO PIP/DIP W/O JOINT SPRING","code_information":[{"code":"Px00027410186","type":"CDM"},{"code":"L3927","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HINGE EXTENSION/FLEX WRIST/FIN","code_information":[{"code":"Px00027410187","type":"CDM"},{"code":"L3900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1533.0,"discounted_cash":1073.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WHF DYNAMIC CF","code_information":[{"code":"Px00027410188","type":"CDM"},{"code":"L3901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1895.0,"discounted_cash":1326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EO  NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410236","type":"CDM"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EWHO RIGID NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410237","type":"CDM"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EWHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410238","type":"CDM"},{"code":"L3764","type":"HCPCS"}],"standard_charges":[{"gross_charge":848.0,"discounted_cash":593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":464.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WHFO RIGID  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410241","type":"CDM"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HFO W/JOINTS W/BANDS CUSTOM","code_information":[{"code":"Px00027410245","type":"CDM"},{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WHO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410269","type":"CDM"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FO PIP/DIP WITH JOINT/SPRING","code_information":[{"code":"Px00027410292","type":"CDM"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHY NON-STRAND IODINE-125 PER SOURCE","code_information":[{"code":"Px00027810501","type":"CDM"},{"code":"C2639","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHY STRANDED PALLADIUM-103 PER SOURCE","code_information":[{"code":"Px00027810504","type":"CDM"},{"code":"C2640","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX SOURCE NS HDR IR-192","code_information":[{"code":"Px00027810509","type":"CDM"},{"code":"C1717","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000010","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000011","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT LAB","code_information":[{"code":"Px00030000026","type":"CDM"},{"code":"89320","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL DRAW FEE","code_information":[{"code":"Px00030010005","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL PROCESSING","code_information":[{"code":"Px00030010007","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - REFERRAL SHIPPING","code_information":[{"code":"Px00030010008","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ZIKA VIRUS IGM ANTIBODY","code_information":[{"code":"Px00030010014","type":"CDM"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE LAB","code_information":[{"code":"Px00030010015","type":"CDM"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTICARDIOLIPIN AB IGG IGM IGA","code_information":[{"code":"Px00030010025","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B5 - PANTOTHENIC ACID","code_information":[{"code":"Px00030010028","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAS ENDOTHELIAL GROWTH FACTOR","code_information":[{"code":"Px00030010030","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 CDM","code_information":[{"code":"Px00030010043","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1535.0,"discounted_cash":1074.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS CDM","code_information":[{"code":"Px00030010044","type":"CDM"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1543.0,"discounted_cash":1080.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PANCRATITIS LIO GSENE SEQ","code_information":[{"code":"Px00030010055","type":"CDM"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3061.0,"discounted_cash":2142.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ROCKY MT SPOTTED FEVER IGG","code_information":[{"code":"Px00030010058","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA DNA/RNA ZIKA VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030010080","type":"CDM"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MGMT GENE METHYLATION ANAL","code_information":[{"code":"Px00030010090","type":"CDM"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM","code_information":[{"code":"Px00030010093","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS BY DIPSTICK","code_information":[{"code":"Px00030010179","type":"CDM"},{"code":"81000","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP","code_information":[{"code":"Px00030010184","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER - PAML","code_information":[{"code":"Px00030010194","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET ANTIBODIES - AB INDIRECT","code_information":[{"code":"Px00030010203","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3061.0,"discounted_cash":2142.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GJB2 GENE ANALYSIS FULL GENE SEQUENCE","code_information":[{"code":"Px00030010229","type":"CDM"},{"code":"81252","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":352.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CXCR4 MOLELCULAR PATHOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030010238","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GALECTIN 3","code_information":[{"code":"Px00030010248","type":"CDM"},{"code":"82777","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL","code_information":[{"code":"Px00030010252","type":"CDM"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":769.0,"discounted_cash":538.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":769.0,"discounted_cash":538.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL LAB","code_information":[{"code":"Px00030010258","type":"CDM"},{"code":"86834","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":513.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL LAB","code_information":[{"code":"Px00030010259","type":"CDM"},{"code":"86835","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":436.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":401.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT GENOTYPE HEPATITIS B VIRUS LAB","code_information":[{"code":"Px00030010264","type":"CDM"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT CDM","code_information":[{"code":"Px00030010267","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FMR1 GENE ALYS EVAL TO DETECT ABNORMAL ALLELES CDM","code_information":[{"code":"Px00030010268","type":"CDM"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1712.0,"discounted_cash":1198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00030010269","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MTHFR GENE ANALYSIS COMMON VARIANTS CDM","code_information":[{"code":"Px00030010270","type":"CDM"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00030010271","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN GENE ANALYSIS","code_information":[{"code":"Px00030010272","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PML/RARALPHA TRANSLOCATION ANALYSIS","code_information":[{"code":"Px00030010273","type":"CDM"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":430.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYP2D6 GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010274","type":"CDM"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HBA1/HBA2 GENE ANALYSIS COMMON DELETIONS/VARIANT LAB","code_information":[{"code":"Px00030010275","type":"CDM"},{"code":"81257","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYSTIC FIBROSIS GENE ANALYSIS","code_information":[{"code":"Px00030010276","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS CDM","code_information":[{"code":"Px00030010279","type":"CDM"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY - CYSTICERCUS","code_information":[{"code":"Px00030010287","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHIKUNGUNYA CDM","code_information":[{"code":"Px00030010288","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC CDM","code_information":[{"code":"Px00030010292","type":"CDM"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS CDM","code_information":[{"code":"Px00030010293","type":"CDM"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RETT SYDROME MECP2 DNA ANAL","code_information":[{"code":"Px00030010294","type":"CDM"},{"code":"81302","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":1316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRG GEENE REARG TCELL IN TBCELL","code_information":[{"code":"Px00030010295","type":"CDM"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":779.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA II TYPING 1 LOCUS LR","code_information":[{"code":"Px00030010300","type":"CDM"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010368","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHADIATOP IGE AB","code_information":[{"code":"Px00030010408","type":"CDM"},{"code":"86005","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES CDM","code_information":[{"code":"Px00030010413","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA2 GLYCOPROT AB IGM (OF PNL)","code_information":[{"code":"Px00030010426","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH CDM","code_information":[{"code":"Px00030010427","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY","code_information":[{"code":"Px00030010429","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT CH50 TOTAL(ARUP)","code_information":[{"code":"Px00030010434","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CCP ANTIBODY","code_information":[{"code":"Px00030010438","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEOXYRIBONUCLEASE ANTIBODY","code_information":[{"code":"Px00030010447","type":"CDM"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - MISC","code_information":[{"code":"Px00030010450","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010452","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY","code_information":[{"code":"Px00030010463","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - ANCA SCREEN","code_information":[{"code":"Px00030010467","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010472","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010474","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010475","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN AB","code_information":[{"code":"Px00030010478","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030010480","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - STRIATED MUSCLE AB 166","code_information":[{"code":"Px00030010481","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NONINFEC AGENT","code_information":[{"code":"Px00030010485","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NONINFEC AG","code_information":[{"code":"Px00030010486","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":1059.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - EA","code_information":[{"code":"Px00030010489","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010492","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN AB","code_information":[{"code":"Px00030010495","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030010496","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - MISC ANTI","code_information":[{"code":"Px00030010507","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER","code_information":[{"code":"Px00030010512","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL AB TITER IGA","code_information":[{"code":"Px00030010518","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER NONINFECT","code_information":[{"code":"Px00030010537","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY CDM","code_information":[{"code":"Px00030010543","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HSV IGM (PANL) 50916","code_information":[{"code":"Px00030010547","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010554","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM","code_information":[{"code":"Px00030010560","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4 (HE4) LAB","code_information":[{"code":"Px00030010562","type":"CDM"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4 - OVARIAN","code_information":[{"code":"Px00030010564","type":"CDM"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010567","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY - GEL DIFFUSION","code_information":[{"code":"Px00030010585","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY - HYPERSENS","code_information":[{"code":"Px00030010586","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY CDM","code_information":[{"code":"Px00030010589","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY","code_information":[{"code":"Px00030010592","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM","code_information":[{"code":"Px00030010599","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS CDM","code_information":[{"code":"Px00030010604","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF","code_information":[{"code":"Px00030010605","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS CDM","code_information":[{"code":"Px00030010606","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030010612","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES CDM","code_information":[{"code":"Px00030010617","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EBV AB NUCLEAR AG IGG","code_information":[{"code":"Px00030010619","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030010623","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY -GAD65","code_information":[{"code":"Px00030010626","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CELL FUNCTION ASSAY W/STIM","code_information":[{"code":"Px00030010631","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT","code_information":[{"code":"Px00030010637","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NK CELLS TOTAL COUNT","code_information":[{"code":"Px00030010641","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT","code_information":[{"code":"Px00030010642","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030010646","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO","code_information":[{"code":"Px00030010648","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO SUBSET","code_information":[{"code":"Px00030010653","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT","code_information":[{"code":"Px00030010657","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010660","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010661","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODY","code_information":[{"code":"Px00030010663","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODY - MISC","code_information":[{"code":"Px00030010671","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN","code_information":[{"code":"Px00030010679","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORDETELLA CDM","code_information":[{"code":"Px00030010682","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ADENOVIRUS CDM","code_information":[{"code":"Px00030010686","type":"CDM"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BACTERIUM ANTIBODY","code_information":[{"code":"Px00030010696","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLASTOMYCES ANTIBODY","code_information":[{"code":"Px00030010706","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY - CSF","code_information":[{"code":"Px00030010727","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY","code_information":[{"code":"Px00030010731","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA CDM","code_information":[{"code":"Px00030010736","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC Q FEVER ANTIBODY I","code_information":[{"code":"Px00030010739","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CRYPTOCOCCUS CDM","code_information":[{"code":"Px00030010747","type":"CDM"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV CDM","code_information":[{"code":"Px00030010751","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CMV ANTIBODY","code_information":[{"code":"Px00030010753","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CMV IGM","code_information":[{"code":"Px00030010762","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM CDM","code_information":[{"code":"Px00030010764","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CMV ANTIBODY IGM","code_information":[{"code":"Px00030010765","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY EARLY ANTIGEN","code_information":[{"code":"Px00030010809","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN","code_information":[{"code":"Px00030010814","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID","code_information":[{"code":"Px00030010822","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGG","code_information":[{"code":"Px00030010823","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGM","code_information":[{"code":"Px00030010824","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EHRLICHIA CDM","code_information":[{"code":"Px00030010834","type":"CDM"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FRANCISELLA TULARENSIS CDM","code_information":[{"code":"Px00030010836","type":"CDM"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI CDM","code_information":[{"code":"Px00030010843","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI CDM","code_information":[{"code":"Px00030010844","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI","code_information":[{"code":"Px00030010846","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI ANTIBODY - IGA","code_information":[{"code":"Px00030010851","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":30.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC HELMINTH ANTIBODY","code_information":[{"code":"Px00030010853","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY - TOXOCARA","code_information":[{"code":"Px00030010855","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY - ECHINOCCUS AB IGG","code_information":[{"code":"Px00030010858","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY - STRONGYLOIDES","code_information":[{"code":"Px00030010859","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HEP DELTA AGENT CDM","code_information":[{"code":"Px00030010872","type":"CDM"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010875","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010878","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HSV IGG (PANL)","code_information":[{"code":"Px00030010879","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010880","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HISTOPLASMA","code_information":[{"code":"Px00030010885","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010889","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030010894","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010897","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TYPE 2","code_information":[{"code":"Px00030010903","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG","code_information":[{"code":"Px00030010906","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010910","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010911","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA CDM","code_information":[{"code":"Px00030010914","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV- 2","code_information":[{"code":"Px00030010922","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010926","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS BE ANTIBODY HBEAB CDM","code_information":[{"code":"Px00030010928","type":"CDM"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA VIRUS ANTIBODY","code_information":[{"code":"Px00030010934","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEGIONELLA ANTIBODY","code_information":[{"code":"Px00030010936","type":"CDM"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEPTOSPIRA ANTIBODY","code_information":[{"code":"Px00030010939","type":"CDM"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA ANTIBODY - PNEUM IGM AB","code_information":[{"code":"Px00030010949","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEASLES AB IGG (PANL)","code_information":[{"code":"Px00030010964","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEASLES AB IGM (PANL)","code_information":[{"code":"Px00030010967","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TETANUS ANTIBODY","code_information":[{"code":"Px00030010979","type":"CDM"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TOXOPLASMA ANTIBODY","code_information":[{"code":"Px00030010982","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA CDM","code_information":[{"code":"Px00030010984","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM CDM","code_information":[{"code":"Px00030010990","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030010996","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TREPONEMA PALLIDUM - AB","code_information":[{"code":"Px00030010999","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VARICELLA ZOSTER AB IGM(PNL)","code_information":[{"code":"Px00030011002","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - IGG","code_information":[{"code":"Px00030011003","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011004","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011006","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VARICELLA ZOSTER AB IGG(PNL)","code_information":[{"code":"Px00030011007","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011008","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011011","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY SCREEN","code_information":[{"code":"Px00030011019","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES","code_information":[{"code":"Px00030011023","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA TYPING A B OR C SINGLE ANTIGEN","code_information":[{"code":"Px00030011030","type":"CDM"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOLOGY PROCEDURE","code_information":[{"code":"Px00030011035","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC ANTIBODY SCREEN - MISC","code_information":[{"code":"Px00030011041","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY CDM","code_information":[{"code":"Px00030011045","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COOMBS TEST DIRECT - ARC DAT","code_information":[{"code":"Px00030011074","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL LAB","code_information":[{"code":"Px00030011076","type":"CDM"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ABO TYPE","code_information":[{"code":"Px00030011088","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION LAB","code_information":[{"code":"Px00030011134","type":"CDM"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONCENTRATION","code_information":[{"code":"Px00030011141","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030011151","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONCENTRATION - PARASITOLOGY","code_information":[{"code":"Px00030011156","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTR BACTERIA EXCEPT BLOOD","code_information":[{"code":"Px00030011159","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA - UREA","code_information":[{"code":"Px00030011165","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOPLASMA ANY SOURCE CDM","code_information":[{"code":"Px00030011166","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOPLASMA ANY SOURCE CDM","code_information":[{"code":"Px00030011168","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA CULTURE","code_information":[{"code":"Px00030011169","type":"CDM"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE CHLAMYDIA ANY SOURCE CDM","code_information":[{"code":"Px00030011170","type":"CDM"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM CDM","code_information":[{"code":"Px00030011175","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM CDM","code_information":[{"code":"Px00030011179","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM","code_information":[{"code":"Px00030011185","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM LAB","code_information":[{"code":"Px00030011188","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MACROSCOPIC EXAM PARASITE","code_information":[{"code":"Px00030011197","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPT MACROBROTH - AFB SENS","code_information":[{"code":"Px00030011221","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI","code_information":[{"code":"Px00030011226","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI - SPUTUM","code_information":[{"code":"Px00030011227","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI - CRYPTOSPORIDUM","code_information":[{"code":"Px00030011231","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT CDM","code_information":[{"code":"Px00030011236","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011248","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011249","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR WET MOUNT SALINE/INK - KOH EXAM","code_information":[{"code":"Px00030011260","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011262","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY TOXIN OR ANTITOXIN","code_information":[{"code":"Px00030011274","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE - HERPES CULTURE","code_information":[{"code":"Px00030011279","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE - VIRAL CULTURE","code_information":[{"code":"Px00030011289","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION SHELL VIA","code_information":[{"code":"Px00030011304","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC CDM","code_information":[{"code":"Px00030011308","type":"CDM"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADENOVIRUS INFECTIOUS AGENT","code_information":[{"code":"Px00030011309","type":"CDM"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY CDM","code_information":[{"code":"Px00030011313","type":"CDM"},{"code":"87271","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA B AG IF","code_information":[{"code":"Px00030011318","type":"CDM"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A AG IF","code_information":[{"code":"Px00030011321","type":"CDM"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEGION PNEUMOPHILIA AG IF","code_information":[{"code":"Px00030011323","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI LEGIONELLA PNEUMOPHILA CDM","code_information":[{"code":"Px00030011325","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PARAINFLUENZA AG IF","code_information":[{"code":"Px00030011326","type":"CDM"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011328","type":"CDM"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI PNEUMOCUSTIS CARINII CDM","code_information":[{"code":"Px00030011331","type":"CDM"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VARICELLA ZOSTER AG IF","code_information":[{"code":"Px00030011337","type":"CDM"},{"code":"87290","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY DETECTION NOS IF","code_information":[{"code":"Px00030011343","type":"CDM"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCUS NEOFORM AG EIA - INFECTIOUS","code_information":[{"code":"Px00030011353","type":"CDM"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM AG EIA","code_information":[{"code":"Px00030011355","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG","code_information":[{"code":"Px00030011359","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011370","type":"CDM"},{"code":"86756","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TRICHINELLA CDM","code_information":[{"code":"Px00030011371","type":"CDM"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS DELTA AGENT ANTIGEN","code_information":[{"code":"Px00030011403","type":"CDM"},{"code":"87380","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA B PARAPERT/B PERTUSSIS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030011420","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS CDM","code_information":[{"code":"Px00030011424","type":"CDM"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANT PCR URINE","code_information":[{"code":"Px00030011428","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS URINE VIRACOR","code_information":[{"code":"Px00030011429","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - EA","code_information":[{"code":"Px00030011463","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - 86235 JO1","code_information":[{"code":"Px00030011469","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN - C5","code_information":[{"code":"Px00030011477","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ENA LAB","code_information":[{"code":"Px00030011488","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RIBOSOMAL PROTEIN","code_information":[{"code":"Px00030011493","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN","code_information":[{"code":"Px00030011497","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HTLV-I ANTIBODY","code_information":[{"code":"Px00030011509","type":"CDM"},{"code":"86687","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030011511","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BARTONELLA DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011518","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT","code_information":[{"code":"Px00030011519","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL","code_information":[{"code":"Px00030011520","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL CSF","code_information":[{"code":"Px00030011521","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL SYNOVIAL","code_information":[{"code":"Px00030011522","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011538","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CANDIDA ANTIGEN","code_information":[{"code":"Px00030011539","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011540","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA PNEUM DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011570","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":876.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS PCR","code_information":[{"code":"Px00030011572","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA","code_information":[{"code":"Px00030011573","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE","code_information":[{"code":"Px00030011574","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS AMNIOTIC 1 KAROTYPE","code_information":[{"code":"Px00030011576","type":"CDM"},{"code":"88269","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING CDM","code_information":[{"code":"Px00030011578","type":"CDM"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CYTOMEGALOVIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030011582","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID CDM","code_information":[{"code":"Px00030011585","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYZE 20-25 CELLS","code_information":[{"code":"Px00030011588","type":"CDM"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011595","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA DERMAL VERICELLA AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030011596","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011609","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FAT STAIN FECES URINE/RESPIR SECRETIONS CDM","code_information":[{"code":"Px00030011616","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY ADD MARKER2","code_information":[{"code":"Px00030011622","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY FIRST MARKER2","code_information":[{"code":"Px00030011628","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011637","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011644","type":"CDM"},{"code":"87516","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":538.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM","code_information":[{"code":"Px00030011646","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C PCR QUAL","code_information":[{"code":"Px00030011651","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C RNA QUANTIFICATION","code_information":[{"code":"Px00030011655","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV-1 DNA PCR","code_information":[{"code":"Px00030011665","type":"CDM"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV-1 DNA QUANTIFICATION","code_information":[{"code":"Px00030011666","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011673","type":"CDM"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA CDM","code_information":[{"code":"Px00030011683","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST CDM","code_information":[{"code":"Px00030011685","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INF AGENT BY NUCLEIC ACID QUAN","code_information":[{"code":"Px00030011690","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":529.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MENINGITIS ENCEPHALITITS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030011691","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT ANTIGEN DETECTION","code_information":[{"code":"Px00030011692","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION AMPLIFIED PROBE","code_information":[{"code":"Px00030011693","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION PCR","code_information":[{"code":"Px00030011694","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011695","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO INFLUENZA CDM","code_information":[{"code":"Px00030011697","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030011698","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA JC VIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030011700","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MALARIA AMPLIFIED PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030011712","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION MANUAL","code_information":[{"code":"Px00030011721","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB CDM","code_information":[{"code":"Px00030011724","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA CDM","code_information":[{"code":"Px00030011739","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011749","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011759","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011762","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE CULTURE LYMPHOCYTE FISH CULTURE","code_information":[{"code":"Px00030011767","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TOXOPLASMA GONDII DNA PROBE","code_information":[{"code":"Px00030011768","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAVEL ALLOWANCE  1 PATIENT","code_information":[{"code":"Px00030011769","type":"CDM"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRAVEL ALLOWANCE  PRORATED/2","code_information":[{"code":"Px00030011773","type":"CDM"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030011861","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - ANCA TITER","code_information":[{"code":"Px00030011864","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030011868","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS CDM","code_information":[{"code":"Px00030011871","type":"CDM"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY -B BURGDORFERI","code_information":[{"code":"Px00030011880","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030011886","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SCL-70 AB IGG(ARUP)","code_information":[{"code":"Px00030011905","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB CDM","code_information":[{"code":"Px00030011930","type":"CDM"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TROPHERYMA WHIPPLE BY PCR","code_information":[{"code":"Px00030011937","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TROPHERYMA WHIPPLEI DNA BY PCR","code_information":[{"code":"Px00030011938","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030011966","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATHETERIZE FOR URINE SPECIMEN P9612","code_information":[{"code":"Px00030011972","type":"CDM"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR II PROTHROMBIN GENE MUTAT","code_information":[{"code":"Px00030011977","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA-B 1502 TYPING","code_information":[{"code":"Px00030011990","type":"CDM"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA I & II TYPING HR","code_information":[{"code":"Px00030011995","type":"CDM"},{"code":"81378","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":536.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROTEIN ANY SOURCE","code_information":[{"code":"Px00030011996","type":"CDM"},{"code":"84160","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME MICROARRAY SNP","code_information":[{"code":"Px00030012011","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1642.0,"discounted_cash":1149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRG GENE REARG TCELL IN TCELL","code_information":[{"code":"Px00030012012","type":"CDM"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACE POLYMORPHISM","code_information":[{"code":"Px00030012014","type":"CDM"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 CDM","code_information":[{"code":"Px00030012016","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL POST DEX 2","code_information":[{"code":"Px00030012029","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE CDM","code_information":[{"code":"Px00030012035","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030012037","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030012042","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTERLEUKIN 6 BY MAFD","code_information":[{"code":"Px00030012050","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA CDM","code_information":[{"code":"Px00030012057","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADENOSINE DEAMINASE CSF/FLUID","code_information":[{"code":"Px00030012065","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TT PT/CT MIX","code_information":[{"code":"Px00030012107","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM","code_information":[{"code":"Px00030012117","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMATIN AUTOANTIBODIES","code_information":[{"code":"Px00030012120","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMRNP AUTOANTIBODY","code_information":[{"code":"Px00030012126","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEURON SPECIFIC ENOLASE","code_information":[{"code":"Px00030012141","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYME IGM BY WESTERN BLOT","code_information":[{"code":"Px00030012171","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COXSACKIE B VIRUS ANTIBODIES","code_information":[{"code":"Px00030012179","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A VIRUS AB IGG","code_information":[{"code":"Px00030012185","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA B VIRUS AB IGG","code_information":[{"code":"Px00030012186","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KARYOTYPING SINGLE","code_information":[{"code":"Px00030012215","type":"CDM"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IGK PCR","code_information":[{"code":"Px00030012217","type":"CDM"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRAF MUTATION ANALYSIS REFLEX","code_information":[{"code":"Px00030012231","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPHILIA RISK F2 GENE","code_information":[{"code":"Px00030012235","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANAEROBIC CULTURE (ISOLATE)","code_information":[{"code":"Px00030012246","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BORDETELLA ANTIBODY ADDL","code_information":[{"code":"Px00030012264","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBAMAZEPINE EPOXIDE","code_information":[{"code":"Px00030012267","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"Px00030012275","type":"CDM"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESETHYLAMIODARONE QUANT CHROM","code_information":[{"code":"Px00030012279","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESMOGLEIN 1 IGG AB","code_information":[{"code":"Px00030012280","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESMOGLEIN 3 IGG AB","code_information":[{"code":"Px00030012281","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EHRLICHIA ANTIBODY IGM","code_information":[{"code":"Px00030012282","type":"CDM"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBDY SCRN ADDL","code_information":[{"code":"Px00030012290","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HEPATITIS E CDM","code_information":[{"code":"Px00030012293","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HHV-6 CDM","code_information":[{"code":"Px00030012295","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPE 1ST LOCUS","code_information":[{"code":"Px00030012297","type":"CDM"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPE 2ND LOCUS","code_information":[{"code":"Px00030012298","type":"CDM"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPE ALLELE GROUP","code_information":[{"code":"Px00030012299","type":"CDM"},{"code":"81383","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA TYPING HLA A LOCUS","code_information":[{"code":"Px00030012300","type":"CDM"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA TYPING HLA B LOCUS","code_information":[{"code":"Px00030012301","type":"CDM"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE CDM","code_information":[{"code":"Px00030012305","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEGAL SPEC COLLECTION","code_information":[{"code":"Px00030012312","type":"CDM"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030012317","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030012318","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY FOR PHENCYCLIDINE","code_information":[{"code":"Px00030012321","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL ANTIBODY ADDL","code_information":[{"code":"Px00030012327","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREKALLIKREIN ASSAY","code_information":[{"code":"Px00030012329","type":"CDM"},{"code":"85292","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ROCKY MT SPOTTED FEVER AB-IGM","code_information":[{"code":"Px00030012338","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP CDM","code_information":[{"code":"Px00030012385","type":"CDM"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINOMYCES ANTIBODY","code_information":[{"code":"Px00030012386","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION CDM","code_information":[{"code":"Px00030012388","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLDX- CEBPA SEQUENCING","code_information":[{"code":"Px00030012402","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ONCOPROTEIN DCP","code_information":[{"code":"Px00030012421","type":"CDM"},{"code":"83951","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GROWTH HORMONE HUMAN ANTIBODY CDM","code_information":[{"code":"Px00030012424","type":"CDM"},{"code":"86277","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD OTHER SOURCES","code_information":[{"code":"Px00030013006","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM","code_information":[{"code":"Px00030013009","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS VOLUME MEASURE","code_information":[{"code":"Px00030013017","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADRENOCORTICOTROPIC HORMONE ACTH CDM","code_information":[{"code":"Px00030013018","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOLASE CDM","code_information":[{"code":"Px00030013019","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN","code_information":[{"code":"Px00030013021","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN CSF","code_information":[{"code":"Px00030013030","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE HALOPRIDOL CDM","code_information":[{"code":"Px00030013038","type":"CDM"},{"code":"80173","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GENERAL HEALTH PANEL","code_information":[{"code":"Px00030013040","type":"CDM"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030013041","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES O2 SAT ONLY","code_information":[{"code":"Px00030013044","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE","code_information":[{"code":"Px00030013047","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"Px00030013048","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030013049","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLINESTERASE ASSAY","code_information":[{"code":"Px00030013050","type":"CDM"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2","code_information":[{"code":"Px00030013061","type":"CDM"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE CDM","code_information":[{"code":"Px00030013064","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4531.0,"discounted_cash":3171.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHLORAMPHENICOL","code_information":[{"code":"Px00030013076","type":"CDM"},{"code":"82415","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLD BY NMR","code_information":[{"code":"Px00030013080","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030013102","type":"CDM"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE CDM","code_information":[{"code":"Px00030013109","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN CDM","code_information":[{"code":"Px00030013120","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN SINGLE DRUG CLASS","code_information":[{"code":"Px00030013123","type":"CDM"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE INHIB B CDM","code_information":[{"code":"Px00030013125","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PYRUVATE KINASE","code_information":[{"code":"Px00030013131","type":"CDM"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHENYLALANINE PKU BLOOD","code_information":[{"code":"Px00030013137","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM DILUTED","code_information":[{"code":"Px00030013139","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030013208","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS FECES QUANTITATIVE","code_information":[{"code":"Px00030013217","type":"CDM"},{"code":"84126","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE AB IGG","code_information":[{"code":"Px00030013230","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC Z82542 (REF LAB)","code_information":[{"code":"Px00030013335","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VOLATILES CDM","code_information":[{"code":"Px00030013528","type":"CDM"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL BLOOD GAS ANALYSIS","code_information":[{"code":"Px00030013772","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MANGANESE CDM","code_information":[{"code":"Px00030013773","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CALPROTECTIN FECAL CDM","code_information":[{"code":"Px00030013774","type":"CDM"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TSH RECEPTOR ANTIBODY","code_information":[{"code":"Px00030013776","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN FREE CDM","code_information":[{"code":"Px00030013780","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030013803","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN S FREE","code_information":[{"code":"Px00030013805","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-GALACTOSIDASE SERUM","code_information":[{"code":"Px00030013825","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIMONY BLOOD","code_information":[{"code":"Px00030013830","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIMONY URINE","code_information":[{"code":"Px00030013831","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030013840","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD PH VENOUS","code_information":[{"code":"Px00030013844","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM SERUM","code_information":[{"code":"Px00030013847","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV ADAMTS13 EA ANAL CDM","code_information":[{"code":"Px00030013855","type":"CDM"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC D-DIMER QUANTITATIVE","code_information":[{"code":"Px00030013861","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED CDM","code_information":[{"code":"Px00030013862","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013878","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HCG QUANTITATIVE","code_information":[{"code":"Px00030013887","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030013889","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL CDM","code_information":[{"code":"Px00030013890","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030013893","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030013895","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INDICANS URINE QUALITATIVE","code_information":[{"code":"Px00030013897","type":"CDM"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00030013920","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYELIN BASIC PROTEIN CSF","code_information":[{"code":"Px00030013923","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C1 ESTERASE INHIBITOR LAB","code_information":[{"code":"Px00030013924","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ONCOPROTEIN HER2 NEU","code_information":[{"code":"Px00030013936","type":"CDM"},{"code":"83950","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PANCREATIC POLYPEPTIDE","code_information":[{"code":"Px00030013942","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN FRAGMENT 1+2","code_information":[{"code":"Px00030013951","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME 85610","code_information":[{"code":"Px00030013952","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG VORICONAZOLE","code_information":[{"code":"Px00030013961","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OSMOTIC FRAGILITY RBC UNINCUBATED CDM","code_information":[{"code":"Px00030013963","type":"CDM"},{"code":"85555","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR CDM","code_information":[{"code":"Px00030013979","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SULFATIDE ANTIBODIES","code_information":[{"code":"Px00030013980","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":415.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEOXYCORTISOL 11- CDM","code_information":[{"code":"Px00030014001","type":"CDM"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC 17-HYDROXYPREGNENOLONE CDM","code_information":[{"code":"Px00030014006","type":"CDM"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA CDM","code_information":[{"code":"Px00030014009","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014052","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030014053","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABG","code_information":[{"code":"Px00030014056","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABG WITH 02 SAT","code_information":[{"code":"Px00030014065","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYL REC MD PANEL UMMUNOASSAY","code_information":[{"code":"Px00030014073","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOL MODULATING AB ASSAY","code_information":[{"code":"Px00030014075","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLINE RECEPTOR AB.ASSY","code_information":[{"code":"Px00030014077","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY CDM","code_information":[{"code":"Px00030014095","type":"CDM"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ADENOSINE DEAMINASE CDM","code_information":[{"code":"Px00030014105","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT ADIPONECTIN CDM","code_information":[{"code":"Px00030014107","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014112","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014113","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN AMNIOTIC FLUID CDM","code_information":[{"code":"Px00030014114","type":"CDM"},{"code":"82106","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE BLD","code_information":[{"code":"Px00030014129","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00030014132","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014151","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL FECE","code_information":[{"code":"Px00030014153","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALUMINUM CDM","code_information":[{"code":"Px00030014159","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALUMINUM CDM","code_information":[{"code":"Px00030014160","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES CDM","code_information":[{"code":"Px00030014161","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE CDM","code_information":[{"code":"Px00030014167","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030014170","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL CDM","code_information":[{"code":"Px00030014217","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC CDM","code_information":[{"code":"Px00030014232","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE CDM","code_information":[{"code":"Px00030014235","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME CDM","code_information":[{"code":"Px00030014236","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID CDM","code_information":[{"code":"Px00030014243","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-GM1","code_information":[{"code":"Px00030014255","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-XA (LOW MOLECUL HEPARIN)","code_information":[{"code":"Px00030014271","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APC RESISTANCE","code_information":[{"code":"Px00030014272","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APC RESISTANCE (HYPERC)","code_information":[{"code":"Px00030014273","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH LAB","code_information":[{"code":"Px00030014283","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030014286","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AROMATIC SOLVENT EXP PNL","code_information":[{"code":"Px00030014287","type":"CDM"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00030014290","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARSENICURINE","code_information":[{"code":"Px00030014300","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ARYLSULFATASE A CDM","code_information":[{"code":"Px00030014306","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY MYELOPEROXIDASE","code_information":[{"code":"Px00030014318","type":"CDM"},{"code":"83876","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE ISOENZYME PANCREATIC","code_information":[{"code":"Px00030014320","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CYCLOSPORINE CDM","code_information":[{"code":"Px00030014330","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CYCLOSPORINE OHSU","code_information":[{"code":"Px00030014331","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRANSFERRIN","code_information":[{"code":"Px00030014358","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN CDM","code_information":[{"code":"Px00030014367","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00030014403","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030014412","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS TOTAL CDM","code_information":[{"code":"Px00030014414","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIO-T-TESTOSTERONE TOTAL","code_information":[{"code":"Px00030014441","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BISMUTH QUANT","code_information":[{"code":"Px00030014443","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030014447","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT LEUKOCYTE WBC AUTOMATED CDM","code_information":[{"code":"Px00030014448","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030014449","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE CDM","code_information":[{"code":"Px00030014462","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM CDM","code_information":[{"code":"Px00030014472","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM QUANT URINE","code_information":[{"code":"Px00030014473","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"Px00030014479","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCITONIN CDM","code_information":[{"code":"Px00030014480","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030014484","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBON DIOXIDE BICARBONATE CDM","code_information":[{"code":"Px00030014495","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE","code_information":[{"code":"Px00030014496","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARNITINE FREE AND TOTAL","code_information":[{"code":"Px00030014497","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CAROTENE CDM","code_information":[{"code":"Px00030014498","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED CDM","code_information":[{"code":"Px00030014500","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CBC WITH DIFF AUTO","code_information":[{"code":"Px00030014514","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CELIAC IMMUNOASSAY QUANT NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030014523","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CENTROMERE ANTIBODY","code_information":[{"code":"Px00030014525","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030014527","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030014538","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLOINESTERASE PLASMA","code_information":[{"code":"Px00030014539","type":"CDM"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"Px00030014542","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL TOTAL","code_information":[{"code":"Px00030014552","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014558","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMIUM URINE","code_information":[{"code":"Px00030014562","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CITRATE CDM","code_information":[{"code":"Px00030014564","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CK-MB","code_information":[{"code":"Px00030014567","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COAGUCHECK WAIVED TESTING","code_information":[{"code":"Px00030014578","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030014579","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030014580","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSS LINKS SERUM","code_information":[{"code":"Px00030014585","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COPPER QUANT URINE","code_information":[{"code":"Px00030014600","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030014603","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE URINE 24 HR","code_information":[{"code":"Px00030014608","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL CDM","code_information":[{"code":"Px00030014625","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL CDM","code_information":[{"code":"Px00030014627","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE-SERUM + URINE","code_information":[{"code":"Px00030014631","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE (REF)","code_information":[{"code":"Px00030014636","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRMP 5 IGG WESTERN BLOT CSF","code_information":[{"code":"Px00030014638","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL CDM","code_information":[{"code":"Px00030014640","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYOFIBRINOGEN PLASMA","code_information":[{"code":"Px00030014641","type":"CDM"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN SERUM","code_information":[{"code":"Px00030014642","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE","code_information":[{"code":"Px00030014646","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE CDM","code_information":[{"code":"Px00030014647","type":"CDM"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYSTATIN C CDM","code_information":[{"code":"Px00030014653","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC CDM","code_information":[{"code":"Px00030014657","type":"CDM"},{"code":"82136","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00030014660","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00030014683","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE CDM","code_information":[{"code":"Px00030014685","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRVVT DILUTED CONFIRMATION","code_information":[{"code":"Px00030014769","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELASTASE PANCREATIC EL1 FECAL","code_information":[{"code":"Px00030014772","type":"CDM"},{"code":"82656","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030014775","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030014776","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL AB IGA","code_information":[{"code":"Px00030014782","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN CDM","code_information":[{"code":"Px00030014795","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOTAL ESTRADIOL CDM","code_information":[{"code":"Px00030014798","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTRIOL LEVEL","code_information":[{"code":"Px00030014801","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR 8","code_information":[{"code":"Px00030014823","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE CDM","code_information":[{"code":"Px00030014825","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN CDM","code_information":[{"code":"Px00030014830","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR II PROTHROMBIN SPECIFIC CDM","code_information":[{"code":"Px00030014832","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS CDM","code_information":[{"code":"Px00030014833","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR CDM","code_information":[{"code":"Px00030014834","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR CDM","code_information":[{"code":"Px00030014848","type":"CDM"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR VIII ACT. ONE STAGE","code_information":[{"code":"Px00030014851","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR VIII VW FACTOR RISTO","code_information":[{"code":"Px00030014859","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR X STUART-PROWER CDM","code_information":[{"code":"Px00030014866","type":"CDM"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XI PTA CDM","code_information":[{"code":"Px00030014867","type":"CDM"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XII HAGEMAN CDM","code_information":[{"code":"Px00030014868","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB CDM","code_information":[{"code":"Px00030014869","type":"CDM"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUANTITATIVE CDM","code_information":[{"code":"Px00030014876","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":673.0,"discounted_cash":471.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL/MATERNAL BLOOD SCREEN","code_information":[{"code":"Px00030014884","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN CDM","code_information":[{"code":"Px00030014889","type":"CDM"},{"code":"85410","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR CDM","code_information":[{"code":"Px00030014890","type":"CDM"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030014892","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID SERUM CDM","code_information":[{"code":"Px00030014898","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM","code_information":[{"code":"Px00030014932","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLYCATED PROTEIN CDM","code_information":[{"code":"Px00030014936","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014937","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014938","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMA GT TOTAL","code_information":[{"code":"Px00030014949","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030014950","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030014951","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030014952","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GASTRIN CDM","code_information":[{"code":"Px00030014962","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030014972","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN AB-IGA IMMUNO (PAML) REPEAT TEST","code_information":[{"code":"Px00030014973","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN AB-IGG IMMUNO (PAML)","code_information":[{"code":"Px00030014974","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE","code_information":[{"code":"Px00030014980","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD","code_information":[{"code":"Px00030014981","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOL ADDL SAMP 3HR","code_information":[{"code":"Px00030014989","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS","code_information":[{"code":"Px00030014990","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE 1 HR","code_information":[{"code":"Px00030014992","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C CDM","code_information":[{"code":"Px00030015020","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE","code_information":[{"code":"Px00030015025","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015027","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION CDM","code_information":[{"code":"Px00030015033","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015036","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HDL","code_information":[{"code":"Px00030015058","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE CDM","code_information":[{"code":"Px00030015065","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015078","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030015096","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OSMOTIC FRAGILITY RBC INCUBATED CDM","code_information":[{"code":"Px00030015103","type":"CDM"},{"code":"85557","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HGB ELECTROPHORESIS FRACTION A2","code_information":[{"code":"Px00030015148","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HGB F QUANTITATIVE","code_information":[{"code":"Px00030015149","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN PLASMA CDM","code_information":[{"code":"Px00030015152","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015164","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOCYSTINE PLASMA (HYPERC)","code_information":[{"code":"Px00030015180","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE CDM","code_information":[{"code":"Px00030015181","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOCYSTINE PLASMA QUANT","code_information":[{"code":"Px00030015182","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOVANILLIC ACID (HVA)","code_information":[{"code":"Px00030015183","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - ARSENIC","code_information":[{"code":"Px00030015188","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - CADMIUM","code_information":[{"code":"Px00030015189","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - LEAD","code_information":[{"code":"Px00030015190","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - MERCURY","code_information":[{"code":"Px00030015191","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - ARSENIC","code_information":[{"code":"Px00030015192","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - LEAD","code_information":[{"code":"Px00030015194","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - MERCURY","code_information":[{"code":"Px00030015195","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IBD IMMUNOASSAY QUANT NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030015198","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ICTOTEST BILIRUBIN","code_information":[{"code":"Px00030015205","type":"CDM"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SERUM-PROTEIN ELP SERUM","code_information":[{"code":"Px00030015206","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015207","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IFE UR-PROTEIN ELP URINE","code_information":[{"code":"Px00030015208","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IFE UR-PROTEIN TOTAL URINE","code_information":[{"code":"Px00030015209","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IGE SERUM TOTAL","code_information":[{"code":"Px00030015213","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN CDM","code_information":[{"code":"Px00030015218","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IGG CSF (ARUP)","code_information":[{"code":"Px00030015221","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015229","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT MITOCHONDRIAL AB M2 CDM","code_information":[{"code":"Px00030015237","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015258","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSULIN LEVEL ASSAY","code_information":[{"code":"Px00030015267","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IRON","code_information":[{"code":"Px00030015298","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KAPPA/LAMBDA FREE LT CHAIN SER","code_information":[{"code":"Px00030015343","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUALITATIVE","code_information":[{"code":"Px00030015358","type":"CDM"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WBC ALKALINE PHOSPHATASE COUNT CDM","code_information":[{"code":"Px00030015366","type":"CDM"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030015371","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00030015375","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD BLOOD","code_information":[{"code":"Px00030015376","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEUCINE AMINOPEPTIDASE S","code_information":[{"code":"Px00030015385","type":"CDM"},{"code":"83670","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015391","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015392","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LIDOCAINE CDM","code_information":[{"code":"Px00030015393","type":"CDM"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIOW CYCLOSPORINE","code_information":[{"code":"Px00030015394","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL - PAML","code_information":[{"code":"Px00030015396","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN (A) CDM","code_information":[{"code":"Px00030015399","type":"CDM"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN SEPARATION & QUANT","code_information":[{"code":"Px00030015401","type":"CDM"},{"code":"83700","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LUP ANTICOAG-DRVVT","code_information":[{"code":"Px00030015407","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE OTHER SOURCE CDM","code_information":[{"code":"Px00030015415","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAG ANTIBODY QUANT.IMMUNOASSAY","code_information":[{"code":"Px00030015419","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MELANIN URINE","code_information":[{"code":"Px00030015435","type":"CDM"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MERCURY QUANT BLOOD","code_information":[{"code":"Px00030015440","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MERCURY URINE QUANTITATIVE","code_information":[{"code":"Px00030015445","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015447","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015448","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015449","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE CDM","code_information":[{"code":"Px00030015458","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE CDM","code_information":[{"code":"Px00030015460","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015466","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT MODIFIED ELISA IGA CDM","code_information":[{"code":"Px00030015471","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT MODIFIED ELISA IGG CDM","code_information":[{"code":"Px00030015472","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUCOPOLYSACCHARIDES ACID QUANTITATIVE CDM","code_information":[{"code":"Px00030015518","type":"CDM"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUSK AB","code_information":[{"code":"Px00030015523","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUSK ANTIBODY","code_information":[{"code":"Px00030015525","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN CDM","code_information":[{"code":"Px00030015558","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEPHELOMETRY EACH ANALYTE NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030015571","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NMR-CHOLESTEROL TOTAL","code_information":[{"code":"Px00030015579","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NMR-LIPOPROTEIN PAR QNT & SUBCLASSES","code_information":[{"code":"Px00030015580","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NORFLUOXETINE","code_information":[{"code":"Px00030015585","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NTX-TELOPEPTIDE URINE","code_information":[{"code":"Px00030015589","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS QUALITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00030015629","type":"CDM"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY STOOL CLINICAL CHEM TEST","code_information":[{"code":"Px00030015630","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OXALATE QUANT URINE","code_information":[{"code":"Px00030015633","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PARANEO AB PANEL IMMUNOASSAY QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030015648","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PARANEOPLASTIC IMMUNO QNT RIA","code_information":[{"code":"Px00030015651","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015660","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE CDM","code_information":[{"code":"Px00030015662","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHENYLALANINE QUANT","code_information":[{"code":"Px00030015686","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY PHOSPHOLIPIDS CDM","code_information":[{"code":"Px00030015687","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS QUANT URINE","code_information":[{"code":"Px00030015691","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS CDM","code_information":[{"code":"Px00030015693","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUC BLD GLUC MNTR DEV","code_information":[{"code":"Px00030015715","type":"CDM"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030015718","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE CDM","code_information":[{"code":"Px00030015719","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY PORPHYRINS EVALUATION CDM","code_information":[{"code":"Px00030015727","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT PORPHYRINS CDM","code_information":[{"code":"Px00030015728","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM FECAL","code_information":[{"code":"Px00030015735","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030015745","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRENATAL-ESTRIOL","code_information":[{"code":"Px00030015746","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00030015747","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRO INSULIN","code_information":[{"code":"Px00030015750","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROCOLLAGEN TYPE 1 N-TERM PEP","code_information":[{"code":"Px00030015752","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROINSULIN CDM","code_information":[{"code":"Px00030015755","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC AG TOT(PAML)","code_information":[{"code":"Px00030015760","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030015763","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015764","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN C ACTIVITY (HYPERC)","code_information":[{"code":"Px00030015767","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN C ACTIVITY","code_information":[{"code":"Px00030015768","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030015772","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN S AG TOTAL","code_information":[{"code":"Px00030015778","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEINASE-3 ANTIBODY EIA","code_information":[{"code":"Px00030015793","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTIME (LUPUS ANTICOAG)","code_information":[{"code":"Px00030015805","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PSA FREE","code_information":[{"code":"Px00030015809","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015810","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PSEUD DIB-DIBUCAINE","code_information":[{"code":"Px00030015812","type":"CDM"},{"code":"82638","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PSEUD DIB-PSEUDOCHOLINESTERASE","code_information":[{"code":"Px00030015813","type":"CDM"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00030015823","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PTT (LUPUS ANTICOAG) PLASMA","code_information":[{"code":"Px00030015830","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRUVATE CDM","code_information":[{"code":"Px00030015836","type":"CDM"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG BROMIDE","code_information":[{"code":"Px00030015838","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG ETHOTOIN","code_information":[{"code":"Px00030015844","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG ITRACONAXOLE","code_information":[{"code":"Px00030015846","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG OLANZAPINE","code_information":[{"code":"Px00030015851","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG PROPAFENONE","code_information":[{"code":"Px00030015853","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030015863","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC CDM","code_information":[{"code":"Px00030015872","type":"CDM"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015879","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015880","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTE AUTOMATED CDM","code_information":[{"code":"Px00030015882","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RETICULATED PLATELET ASSAY CDM","code_information":[{"code":"Px00030015883","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RIBOSOME P AB","code_information":[{"code":"Px00030015887","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RVVT DILUTED CONFIRM","code_information":[{"code":"Px00030015897","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030015901","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SENDOUT GLYCOSYLATED HEMOGLOBIN","code_information":[{"code":"Px00030015902","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEROTONIN","code_information":[{"code":"Px00030015924","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"Px00030015928","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SGPG ANTIBODY QUANT.IMMUNOASSY","code_information":[{"code":"Px00030015930","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030015934","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015957","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SOMATOSTATIN","code_information":[{"code":"Px00030015959","type":"CDM"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE CDM","code_information":[{"code":"Px00030015963","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PH STOOL CDM","code_information":[{"code":"Px00030015971","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT STRIATIONAL AB CDM","code_information":[{"code":"Px00030015974","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM","code_information":[{"code":"Px00030015997","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE CDM","code_information":[{"code":"Px00030015998","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"Px00030016000","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL CDM","code_information":[{"code":"Px00030016009","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE FREE","code_information":[{"code":"Px00030016011","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030016020","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030016021","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THIOCYANATE.","code_information":[{"code":"Px00030016025","type":"CDM"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THIOPURINE LEVEL","code_information":[{"code":"Px00030016026","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN III ACTIVITY","code_information":[{"code":"Px00030016030","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY LAB","code_information":[{"code":"Px00030016031","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME (LUPUS ANTICOAG)","code_information":[{"code":"Px00030016032","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROXINE T4","code_information":[{"code":"Px00030016044","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIN SERUM QUANTITATIVE","code_information":[{"code":"Px00030016048","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030016053","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030016055","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA CDM","code_information":[{"code":"Px00030016070","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE TRYPTASE CDM","code_information":[{"code":"Px00030016097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUMOR NECROSIS FACTOR-ALPHA","code_information":[{"code":"Px00030016107","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UREA QUANT URINE","code_information":[{"code":"Px00030016112","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC USC THYROGLUBLIN LEVEL","code_information":[{"code":"Px00030016153","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VANILLYLMANDELIC ACID URN ARUP","code_information":[{"code":"Px00030016165","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VERY LONG CHAIN FATTY ACIDS","code_information":[{"code":"Px00030016177","type":"CDM"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRIDOXAL PHOSPHATE CDM","code_information":[{"code":"Px00030016188","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VITAMIN-B12","code_information":[{"code":"Px00030016196","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE CDM","code_information":[{"code":"Px00030016198","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE GATED CA CHANNEL AB","code_information":[{"code":"Px00030016203","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS CDM","code_information":[{"code":"Px00030016210","type":"CDM"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VW PAN-FACTOR VIII ONE STAGE","code_information":[{"code":"Px00030016212","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT CDM","code_information":[{"code":"Px00030016213","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030016220","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00030016230","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC LAB","code_information":[{"code":"Px00030016232","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE APOLIPOPROTEIN EACH","code_information":[{"code":"Px00030016235","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE BILIRUBIN TOTAL","code_information":[{"code":"Px00030016236","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE GGT","code_information":[{"code":"Px00030016237","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE HAPTOGLOBIN QUANTITATIVE","code_information":[{"code":"Px00030016238","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE NEPHELOMETRY EACH ANALYTE","code_information":[{"code":"Px00030016239","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC V FIBROSURE SGPT","code_information":[{"code":"Px00030016240","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MORPHOMETRIC ANALYSIS IN SITU HYBRIDIZATION (QUANTITATIVE","code_information":[{"code":"Px00030016241","type":"CDM"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA CDM","code_information":[{"code":"Px00030016242","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHIGATOXIN","code_information":[{"code":"Px00030016243","type":"CDM"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030016244","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE CELIAC CDM","code_information":[{"code":"Px00030016245","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030016259","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRONCH LAVAGE DIFFERENTIAL","code_information":[{"code":"Px00030016260","type":"CDM"},{"code":"85999","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLEXIMAB/HACA QUANT ANTIBODY","code_information":[{"code":"Px00030016270","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COBALT SERUM","code_information":[{"code":"Px00030016272","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES CDM","code_information":[{"code":"Px00030016273","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030016275","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016279","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016280","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET ASSOCIATED ANTIBODY","code_information":[{"code":"Px00030016281","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030016284","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN","code_information":[{"code":"Px00030016288","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00030016289","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00030016290","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00030016292","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS CDM","code_information":[{"code":"Px00030016293","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL CDM","code_information":[{"code":"Px00030016295","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FIBRIN SPLIT PRODUCTS QUAL","code_information":[{"code":"Px00030016320","type":"CDM"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYSOZYME","code_information":[{"code":"Px00030016329","type":"CDM"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 LAB","code_information":[{"code":"Px00030016330","type":"CDM"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HEPATITIS CDM","code_information":[{"code":"Px00030016336","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CBC","code_information":[{"code":"Px00030017008","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRP","code_information":[{"code":"Px00030017011","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PROFILE","code_information":[{"code":"Px00030017031","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030017035","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KRAS MOPATH PROC LVL4(40248)","code_information":[{"code":"Px00030017047","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APO E CARDIAC RISK ISO(55566)","code_information":[{"code":"Px00030017048","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE CDM","code_information":[{"code":"Px00030017049","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA I TYPING  LOW RESOLUTION  ONE ANTIGEN","code_information":[{"code":"Px00030017051","type":"CDM"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE CDM","code_information":[{"code":"Px00030017062","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANALYSIS GENE SEPT9","code_information":[{"code":"Px00030017104","type":"CDM"},{"code":"81327","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUTATHIONE","code_information":[{"code":"Px00030017107","type":"CDM"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHOHEXOSE ISOMERASE","code_information":[{"code":"Px00030017108","type":"CDM"},{"code":"84087","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRCA1&2 SEQ & FULL DUP/DEL","code_information":[{"code":"Px00030050113","type":"CDM"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":4135.0,"discounted_cash":2894.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS CDM","code_information":[{"code":"Px00030050114","type":"CDM"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CEBPA GENE ANALYSIS FULL GENE SEQUENCE CDM","code_information":[{"code":"Px00030050115","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030050116","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":506.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ADDL VARIANTS","code_information":[{"code":"Px00030050117","type":"CDM"},{"code":"81276","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100001","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100002","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100003","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030100007","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100014","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE BLOOD LAB","code_information":[{"code":"Px00030100021","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL","code_information":[{"code":"Px00030100022","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030100023","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100038","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN LAB","code_information":[{"code":"Px00030100039","type":"CDM"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY AMIODARONE LAB","code_information":[{"code":"Px00030100040","type":"CDM"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY FELBAMATE LAB","code_information":[{"code":"Px00030100042","type":"CDM"},{"code":"80167","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY FLECAINIDE LAB","code_information":[{"code":"Px00030100044","type":"CDM"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY ITRACONAZOLE LAB","code_information":[{"code":"Px00030100045","type":"CDM"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY LEFLUNOMIDE LAB","code_information":[{"code":"Px00030100046","type":"CDM"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY METHOTREXATE LAB","code_information":[{"code":"Px00030100047","type":"CDM"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY RUFINAMIDE","code_information":[{"code":"Px00030100048","type":"CDM"},{"code":"80210","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA LAB","code_information":[{"code":"Px00030100049","type":"CDM"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100053","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE LAB","code_information":[{"code":"Px00030100054","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100055","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL LAB","code_information":[{"code":"Px00030100069","type":"CDM"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 LAB","code_information":[{"code":"Px00030100073","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE LAB","code_information":[{"code":"Px00030100075","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100085","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOVANILLIC ACID LAB","code_information":[{"code":"Px00030100086","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100104","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100111","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100113","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030100114","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100117","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100118","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3","code_information":[{"code":"Px00030100119","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100120","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100121","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100122","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100123","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100124","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100125","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100126","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM","code_information":[{"code":"Px00030100127","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030100128","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE","code_information":[{"code":"Px00030100129","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100130","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTOSOL FREE LAB","code_information":[{"code":"Px00030100131","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME LAB","code_information":[{"code":"Px00030100132","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100133","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100134","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100135","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100136","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100138","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100140","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100142","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030100144","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030100145","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100147","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100150","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030100151","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100154","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY LAB","code_information":[{"code":"Px00030100157","type":"CDM"},{"code":"82608","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030100158","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100159","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY BIOVLBL TESTOSTERONE DIRECT MEASUREMENT LAB","code_information":[{"code":"Px00030100160","type":"CDM"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100161","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100162","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE LAB","code_information":[{"code":"Px00030100163","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100164","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS LAB","code_information":[{"code":"Px00030100165","type":"CDM"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE LAB","code_information":[{"code":"Px00030100166","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 LAB","code_information":[{"code":"Px00030100167","type":"CDM"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE LAB","code_information":[{"code":"Px00030100168","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030100169","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030100170","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 LAB","code_information":[{"code":"Px00030100171","type":"CDM"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL LAB","code_information":[{"code":"Px00030100172","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS LAB","code_information":[{"code":"Px00030100173","type":"CDM"},{"code":"80374","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER LAB","code_information":[{"code":"Px00030100175","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS CDM","code_information":[{"code":"Px00030100178","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100184","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH LAB","code_information":[{"code":"Px00030100185","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100186","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100187","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","code_information":[{"code":"Px00030100203","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100215","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":1003.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100216","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOTAL ESTRADIOL LAB","code_information":[{"code":"Px00030100220","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL LAB","code_information":[{"code":"Px00030100221","type":"CDM"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100224","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030100226","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030100227","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100228","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE LAB","code_information":[{"code":"Px00030100229","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL","code_information":[{"code":"Px00030100231","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL","code_information":[{"code":"Px00030100232","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOHYDRATE DEFICIENT TRANSFERRIN LAB","code_information":[{"code":"Px00030100237","type":"CDM"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030100242","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030100243","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL LAB","code_information":[{"code":"Px00030100244","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100245","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030100246","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE LAB","code_information":[{"code":"Px00030100256","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATINE LAB","code_information":[{"code":"Px00030100257","type":"CDM"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100258","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100259","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2","code_information":[{"code":"Px00030100261","type":"CDM"},{"code":"80332","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100268","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE LAB","code_information":[{"code":"Px00030100269","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030100284","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100313","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100349","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NORTRIPTYLINE LEVEL SERUM LAB","code_information":[{"code":"Px00030100350","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE LEVEL LAB","code_information":[{"code":"Px00030100351","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOBAZAM LAB","code_information":[{"code":"Px00030100355","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BACLOFEN LEVEL LAB","code_information":[{"code":"Px00030100357","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREGABALIN LEVEL LAB","code_information":[{"code":"Px00030100358","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUETIAPINE (SEROQUE) LEVEL LAB","code_information":[{"code":"Px00030100359","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OLANZAPINE (ZYPREXA) LEVEL LAB","code_information":[{"code":"Px00030100363","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DOXEPIN AND NORDOXEPIN SERUM","code_information":[{"code":"Px00030100364","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DABIGATRAN LEVEL LAB","code_information":[{"code":"Px00030100367","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ZIPRASIDONE LEVEL LAB","code_information":[{"code":"Px00030100368","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MERCAPTOPURINE LAB","code_information":[{"code":"Px00030100369","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030100376","type":"CDM"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100377","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100382","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED","code_information":[{"code":"Px00030100388","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030100389","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100392","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100396","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100397","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100406","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100407","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100414","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100415","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100428","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100432","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030100433","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN LAB","code_information":[{"code":"Px00030100434","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100456","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100457","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT LAB","code_information":[{"code":"Px00030100458","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100459","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES LAB","code_information":[{"code":"Px00030100460","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030100461","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100462","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100463","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100465","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE LAB","code_information":[{"code":"Px00030100467","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATIC FUNCTION PANEL LAB","code_information":[{"code":"Px00030100468","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030100469","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100470","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY URINE LAB","code_information":[{"code":"Px00030100471","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE LAB","code_information":[{"code":"Px00030100472","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC URINE LAB","code_information":[{"code":"Px00030100473","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SULFATE URINE LAB","code_information":[{"code":"Px00030100474","type":"CDM"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CHLORIDE LAB","code_information":[{"code":"Px00030100475","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100486","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100489","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100490","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100491","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100493","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100500","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100508","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030100509","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030100513","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS LAB","code_information":[{"code":"Px00030100517","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100518","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 LAB","code_information":[{"code":"Px00030100523","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100524","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE LAB","code_information":[{"code":"Px00030100525","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030100526","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLPHEN LAB","code_information":[{"code":"Px00030100531","type":"CDM"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY RUFINAMIDE LAB","code_information":[{"code":"Px00030100537","type":"CDM"},{"code":"80210","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY THIOPURINE S-METHYLTRANSFERASE LAB","code_information":[{"code":"Px00030100540","type":"CDM"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100541","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100542","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS LAB","code_information":[{"code":"Px00030100543","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100545","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100546","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100547","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100548","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100549","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100550","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100551","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100552","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100553","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100554","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100555","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100557","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030100559","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030100560","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100561","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100564","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100565","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100567","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030100568","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100569","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100570","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100572","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM LAB","code_information":[{"code":"Px00030100573","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030100575","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030100577","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100579","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100580","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100581","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100584","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL LAB","code_information":[{"code":"Px00030100585","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100587","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100589","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100590","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100591","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100593","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100594","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100596","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL LAB","code_information":[{"code":"Px00030100597","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL LAB","code_information":[{"code":"Px00030100598","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100603","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100604","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100605","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100607","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100608","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100609","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100610","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE LAB","code_information":[{"code":"Px00030100616","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE","code_information":[{"code":"Px00030100617","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION","code_information":[{"code":"Px00030100618","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030100620","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100621","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN FREE LAB","code_information":[{"code":"Px00030100623","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100624","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100625","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE LAB","code_information":[{"code":"Px00030100626","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030100627","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100628","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE LAB","code_information":[{"code":"Px00030100629","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100636","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100637","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100638","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100640","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREGNANCY-ASSOCIATED PLASMA PROTEIN-A LAB","code_information":[{"code":"Px00030100642","type":"CDM"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREGNANCY-ASSOCIATED PLASMA PROTEIN-A LAB","code_information":[{"code":"Px00030100643","type":"CDM"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100644","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100645","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030100646","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030100647","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE LAB","code_information":[{"code":"Px00030100649","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROINSULIN LAB","code_information":[{"code":"Px00030100650","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100653","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100654","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100655","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100656","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100662","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100665","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100666","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100667","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID LAB","code_information":[{"code":"Px00030100668","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100670","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100671","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100672","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE LAB","code_information":[{"code":"Px00030100673","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100674","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 LAB","code_information":[{"code":"Px00030100676","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE","code_information":[{"code":"Px00030100677","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE","code_information":[{"code":"Px00030100678","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100679","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUTATHIONE LAB","code_information":[{"code":"Px00030100680","type":"CDM"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100681","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100682","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3","code_information":[{"code":"Px00030100683","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100684","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100685","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100686","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030100687","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC LAB","code_information":[{"code":"Px00030100688","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100689","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100690","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100691","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100692","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100693","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100694","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100695","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100697","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100700","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030100701","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100702","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY LAB","code_information":[{"code":"Px00030100703","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY LAB","code_information":[{"code":"Px00030100704","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100705","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100706","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100707","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100708","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100710","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100711","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 LAB","code_information":[{"code":"Px00030100712","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100713","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYSTATIN C LAB","code_information":[{"code":"Px00030100714","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100717","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100718","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100719","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100720","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA LAB","code_information":[{"code":"Px00030100722","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2","code_information":[{"code":"Px00030100725","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE","code_information":[{"code":"Px00030100731","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100732","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030100740","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 LAB","code_information":[{"code":"Px00030100741","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100742","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE LAB","code_information":[{"code":"Px00030100743","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY LAB","code_information":[{"code":"Px00030100759","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030100760","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100761","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100763","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"Px00030100764","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100766","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100767","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100768","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB","code_information":[{"code":"Px00030100770","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100771","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC LAB","code_information":[{"code":"Px00030100772","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030100773","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030100774","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100775","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE LAB","code_information":[{"code":"Px00030100776","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100777","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030100779","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100780","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100782","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100783","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100784","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100786","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100810","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTAGLNDIN EACH LAB","code_information":[{"code":"Px00030100811","type":"CDM"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100814","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS LAB","code_information":[{"code":"Px00030100815","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100816","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100817","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030100818","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100819","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYANOCOBALAMIN VITAMIN B-12 LAB","code_information":[{"code":"Px00030100820","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100822","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030100823","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INTERLEUKIN-6 (IL-6) LAB","code_information":[{"code":"Px00030100824","type":"CDM"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100825","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH LAB","code_information":[{"code":"Px00030100826","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100827","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUTAMYLTRASE GAMMA LAB","code_information":[{"code":"Px00030100830","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100831","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100835","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OBSTETRIC PANEL","code_information":[{"code":"Px00030100836","type":"CDM"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100837","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE LAB","code_information":[{"code":"Px00030100838","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100839","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030100841","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030100842","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100855","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100856","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100857","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100858","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100859","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100860","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE LAB","code_information":[{"code":"Px00030100861","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100891","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100892","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG CHLORPROMAZINE LAB","code_information":[{"code":"Px00030100902","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG ARIPIPRAZOLE","code_information":[{"code":"Px00030100904","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG FLUVOXAMINE LAB","code_information":[{"code":"Px00030100905","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG AMPHETAMINE LAB","code_information":[{"code":"Px00030100906","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG MELATONIN LAB","code_information":[{"code":"Px00030100907","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG BUSPRIONE LAB","code_information":[{"code":"Px00030100908","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":223.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG CLONAZEPAM LAB","code_information":[{"code":"Px00030100910","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG DESIPRAMINE LAB","code_information":[{"code":"Px00030100911","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG IMIPRAMINE AND DESIPRAMINE LAB","code_information":[{"code":"Px00030100912","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030101041","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101042","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030101043","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101044","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101046","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030101052","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101058","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY LAB","code_information":[{"code":"Px00030101087","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030101088","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030101089","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN LAB","code_information":[{"code":"Px00030101090","type":"CDM"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030101278","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN LAB","code_information":[{"code":"Px00030101279","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030101290","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101324","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HISTOPLASMA AG EIA URINE(ARUP)","code_information":[{"code":"Px00030110012","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEP C AB REFLEXIVE","code_information":[{"code":"Px00030110014","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE LAB","code_information":[{"code":"Px00030110078","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3","code_information":[{"code":"Px00030110080","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES LAB","code_information":[{"code":"Px00030110081","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110082","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA","code_information":[{"code":"Px00030110087","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030110089","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL OF NMR","code_information":[{"code":"Px00030110101","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110104","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIRECT THROMBIN INHIBITORS LAB","code_information":[{"code":"Px00030110126","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CAFFEINE LAB","code_information":[{"code":"Px00030110127","type":"CDM"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CLOZAPINE LAB","code_information":[{"code":"Px00030110128","type":"CDM"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT EVEROLIMUS LAB","code_information":[{"code":"Px00030110129","type":"CDM"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GABAPENTIN LAB","code_information":[{"code":"Px00030110130","type":"CDM"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE LAB","code_information":[{"code":"Px00030110131","type":"CDM"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"Px00030110132","type":"CDM"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE MYCOPHENOLATE LAB","code_information":[{"code":"Px00030110133","type":"CDM"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUANT OXCARBAZEPIN LAB","code_information":[{"code":"Px00030110134","type":"CDM"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT TIAGABINE","code_information":[{"code":"Px00030110135","type":"CDM"},{"code":"80199","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ZONISAMIDE LAB","code_information":[{"code":"Px00030110136","type":"CDM"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUGS OF ABUSE URINE","code_information":[{"code":"Px00030110155","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030110158","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030110165","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110166","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110167","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110168","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES LAB","code_information":[{"code":"Px00030110172","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MOLELCULAR PATHOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030110177","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.0,"discounted_cash":1096.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030110181","type":"CDM"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030110182","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE","code_information":[{"code":"Px00030110187","type":"CDM"},{"code":"81445","type":"HCPCS"}],"standard_charges":[{"gross_charge":5357.0,"discounted_cash":3749.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE LAB","code_information":[{"code":"Px00030110188","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PARATHORMONE LAB","code_information":[{"code":"Px00030110189","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110193","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110194","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HTT GENE ANALYSIS DETECT ABNORMAL ALLELES","code_information":[{"code":"Px00030110195","type":"CDM"},{"code":"81271","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT","code_information":[{"code":"Px00030110201","type":"CDM"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030110211","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110212","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030110216","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE","code_information":[{"code":"Px00030110217","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030110218","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR CDM","code_information":[{"code":"Px00030110219","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3","code_information":[{"code":"Px00030110222","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110223","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL","code_information":[{"code":"Px00030110224","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030110227","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3","code_information":[{"code":"Px00030110231","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN LAB","code_information":[{"code":"Px00030110232","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE LAB","code_information":[{"code":"Px00030110233","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE LAB","code_information":[{"code":"Px00030110237","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY ADALIMUMAB LAB","code_information":[{"code":"Px00030110238","type":"CDM"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY POSACONAZOLE CDM","code_information":[{"code":"Px00030110239","type":"CDM"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB","code_information":[{"code":"Px00030110240","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY LACOSAMIDE LAB","code_information":[{"code":"Px00030110241","type":"CDM"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY VEDOLIZUMAB CDM","code_information":[{"code":"Px00030110242","type":"CDM"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY VORICONAZOLE LAB","code_information":[{"code":"Px00030110243","type":"CDM"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FATTY ACIDS NONESTERIFIED LAB","code_information":[{"code":"Px00030110244","type":"CDM"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030110245","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030110246","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030110247","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030110250","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030110254","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030110256","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030110257","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030110258","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030110259","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5 LAB","code_information":[{"code":"Px00030110260","type":"CDM"},{"code":"80333","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE","code_information":[{"code":"Px00030110261","type":"CDM"},{"code":"80337","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030110267","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL OR QUANT NOS 7 OR MORE","code_information":[{"code":"Px00030110268","type":"CDM"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 3 OR 4","code_information":[{"code":"Px00030110271","type":"CDM"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN","code_information":[{"code":"Px00030110303","type":"CDM"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN LAB","code_information":[{"code":"Px00030110304","type":"CDM"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030110305","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"Px00030110317","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIHYDROTESTOSTERONE (DHT) LAB","code_information":[{"code":"Px00030110364","type":"CDM"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CC MSC PMP22 DELETION/DUPLICATION ANALYSIS","code_information":[{"code":"Px00030110411","type":"CDM"},{"code":"81324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030110444","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030110456","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2","code_information":[{"code":"Px00030110459","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTAGLNDIN EACH LAB","code_information":[{"code":"Px00030110476","type":"CDM"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTAGLNDIN EACH LAB","code_information":[{"code":"Px00030110478","type":"CDM"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030110479","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110480","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030110483","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030110484","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE","code_information":[{"code":"Px00030110495","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE","code_information":[{"code":"Px00030110497","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE","code_information":[{"code":"Px00030110501","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110505","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110507","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE","code_information":[{"code":"Px00030110508","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL CDM","code_information":[{"code":"Px00030110510","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE","code_information":[{"code":"Px00030110516","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030110527","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA LAB","code_information":[{"code":"Px00030110531","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE LAB","code_information":[{"code":"Px00030110532","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030110534","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATINE LAB","code_information":[{"code":"Px00030110538","type":"CDM"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SULFATE URINE LAB","code_information":[{"code":"Px00030110539","type":"CDM"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030110541","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00030110557","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030110559","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP","code_information":[{"code":"Px00030110569","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE PLASMA LAB","code_information":[{"code":"Px00030110584","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA FETOPROTEIN TUMOR MARKER","code_information":[{"code":"Px00030110587","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE LAB","code_information":[{"code":"Px00030110601","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030110603","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE LAB","code_information":[{"code":"Px00030110629","type":"CDM"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS CDM","code_information":[{"code":"Px00030110635","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030110636","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOS","code_information":[{"code":"Px00030110638","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMPHETAMINES 5 OR MORE","code_information":[{"code":"Px00030110641","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANABOLIC STEROID 1 OR 2","code_information":[{"code":"Px00030110642","type":"CDM"},{"code":"80327","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2","code_information":[{"code":"Px00030110644","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 6/MORE","code_information":[{"code":"Px00030110646","type":"CDM"},{"code":"80331","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS CLASS 1 OR 2","code_information":[{"code":"Px00030110647","type":"CDM"},{"code":"80332","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS CLASS 6/MORE","code_information":[{"code":"Px00030110649","type":"CDM"},{"code":"80334","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2","code_information":[{"code":"Px00030110650","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE CDM","code_information":[{"code":"Px00030110652","type":"CDM"},{"code":"80337","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030110653","type":"CDM"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3","code_information":[{"code":"Px00030110654","type":"CDM"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE","code_information":[{"code":"Px00030110656","type":"CDM"},{"code":"80341","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3","code_information":[{"code":"Px00030110657","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOS 7/MORE","code_information":[{"code":"Px00030110659","type":"CDM"},{"code":"80344","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES CDM","code_information":[{"code":"Px00030110660","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BENZODIAZEPINES 13 OR MORE","code_information":[{"code":"Px00030110662","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030110663","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CANNABINOIDS NATURAL","code_information":[{"code":"Px00030110664","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE","code_information":[{"code":"Px00030110668","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL CDM","code_information":[{"code":"Px00030110669","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GABAPENTIN NON-BLOOD","code_information":[{"code":"Px00030110670","type":"CDM"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE CDM","code_information":[{"code":"Px00030110671","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING KETAMINE AND NORKETAMINE LAB","code_information":[{"code":"Px00030110672","type":"CDM"},{"code":"80357","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE CDM","code_information":[{"code":"Px00030110673","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110674","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METHYLPHENIDATE","code_information":[{"code":"Px00030110675","type":"CDM"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPIATES 1 OR MORE","code_information":[{"code":"Px00030110676","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPIOID &OPIATE ANALOG 5/MORE","code_information":[{"code":"Px00030110679","type":"CDM"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110680","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PREGABALIN","code_information":[{"code":"Px00030110681","type":"CDM"},{"code":"80366","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE","code_information":[{"code":"Px00030110682","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING SEDATIVE HYPNOTICS CDM","code_information":[{"code":"Px00030110683","type":"CDM"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SKELETAL MUSCLE RELAXANT 1 OR 2","code_information":[{"code":"Px00030110684","type":"CDM"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SKEL MUSC RELAXANT 3 OR MORE","code_information":[{"code":"Px00030110685","type":"CDM"},{"code":"80370","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STIMULANTS SYNTHETIC","code_information":[{"code":"Px00030110686","type":"CDM"},{"code":"80371","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TAPENTADOL","code_information":[{"code":"Px00030110687","type":"CDM"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030110688","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STEREOISOMER ANALYSIS","code_information":[{"code":"Px00030110689","type":"CDM"},{"code":"80374","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3","code_information":[{"code":"Px00030110690","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE CDM","code_information":[{"code":"Px00030110692","type":"CDM"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METHADONE-METAB UR GC/MS (ARUP)","code_information":[{"code":"Px00030110694","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG CONFIRMATION THC","code_information":[{"code":"Px00030110716","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BENZO UR GC/MS (ARUP)","code_information":[{"code":"Px00030110729","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FENTANYL CONFIRM-QNT URINE(ARUP)","code_information":[{"code":"Px00030110730","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC","code_information":[{"code":"Px00030110738","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030110741","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110762","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030110763","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030110765","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030110769","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030110801","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030110807","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2214.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030110808","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACYLCARNITINES QUANTIATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030110810","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN LAB","code_information":[{"code":"Px00030110812","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN LAB","code_information":[{"code":"Px00030110813","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN LAB","code_information":[{"code":"Px00030110814","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN LAB","code_information":[{"code":"Px00030110815","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030110824","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030110846","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN","code_information":[{"code":"Px00030110916","type":"CDM"},{"code":"84449","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN LAB","code_information":[{"code":"Px00030112012","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030112022","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TEST FOR ACETONE/KETONES","code_information":[{"code":"Px00030112025","type":"CDM"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CREATININE","code_information":[{"code":"Px00030112028","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"Px00030112033","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN A LAB","code_information":[{"code":"Px00030112039","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NUCLEOTIDASE 5 LAB","code_information":[{"code":"Px00030112041","type":"CDM"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL CDM","code_information":[{"code":"Px00030112046","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE CDM","code_information":[{"code":"Px00030112048","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENIN","code_information":[{"code":"Px00030112051","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE CDM","code_information":[{"code":"Px00030112054","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OBSTETRIC PANEL LAB","code_information":[{"code":"Px00030112076","type":"CDM"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE CDM","code_information":[{"code":"Px00030112077","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ACID PROSTATIC LAB","code_information":[{"code":"Px00030112081","type":"CDM"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CYANIDE","code_information":[{"code":"Px00030112082","type":"CDM"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE LAB","code_information":[{"code":"Px00030112083","type":"CDM"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL","code_information":[{"code":"Px00030112087","type":"CDM"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE LAB","code_information":[{"code":"Px00030112091","type":"CDM"},{"code":"80192","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SIROLIMUS","code_information":[{"code":"Px00030112093","type":"CDM"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOPIRAMATE LAB","code_information":[{"code":"Px00030112094","type":"CDM"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE QUINIDINE CDM","code_information":[{"code":"Px00030112097","type":"CDM"},{"code":"80194","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY GLUCOSE BLOOD QUANT","code_information":[{"code":"Px00030112099","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE LAB","code_information":[{"code":"Px00030112119","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE LAB","code_information":[{"code":"Px00030112120","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PRIMIDONE LAB","code_information":[{"code":"Px00030112124","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG LAMOTRIGINE","code_information":[{"code":"Px00030112130","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HEMOSIDERIN QUALITATIVE LAB","code_information":[{"code":"Px00030112135","type":"CDM"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLYCATED PROTEIN","code_information":[{"code":"Px00030112136","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCULUS SPECTROSCOPY","code_information":[{"code":"Px00030112138","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030112142","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROINSULIN","code_information":[{"code":"Px00030112143","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES LAB","code_information":[{"code":"Px00030112144","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DHEA","code_information":[{"code":"Px00030112148","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTH STIMULATION PANEL","code_information":[{"code":"Px00030112151","type":"CDM"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG CAFFEINE","code_information":[{"code":"Px00030112177","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL IMMUNE","code_information":[{"code":"Px00030112178","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN K LAB","code_information":[{"code":"Px00030112185","type":"CDM"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID LAB","code_information":[{"code":"Px00030112187","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE LAB","code_information":[{"code":"Px00030112190","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG AMIODARONE","code_information":[{"code":"Px00030112196","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FLECAINIDE","code_information":[{"code":"Px00030112197","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUCAGON LAB","code_information":[{"code":"Px00030112198","type":"CDM"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE CDM","code_information":[{"code":"Px00030112199","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY RBC CHOLINESTERASE","code_information":[{"code":"Px00030112203","type":"CDM"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG CLOZAPINE","code_information":[{"code":"Px00030112210","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHATASE ACID TOTAL","code_information":[{"code":"Px00030112212","type":"CDM"},{"code":"84060","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG METHOTREXATE LAB","code_information":[{"code":"Px00030112215","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030112216","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030112219","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTROGENS TOTAL LAB","code_information":[{"code":"Px00030112220","type":"CDM"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG DIGITOXIN LAB","code_information":[{"code":"Px00030112223","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FELBAMATE","code_information":[{"code":"Px00030112224","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG TRAZADONE","code_information":[{"code":"Px00030112236","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC","code_information":[{"code":"Px00030112242","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG DISOPYRAMIDE","code_information":[{"code":"Px00030112249","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL","code_information":[{"code":"Px00030112251","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG","code_information":[{"code":"Px00030112260","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN CLEARANCE LAB","code_information":[{"code":"Px00030112261","type":"CDM"},{"code":"84545","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112268","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHENCYCLIDINE","code_information":[{"code":"Px00030112274","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG FLUXETINE","code_information":[{"code":"Px00030112275","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN CDM","code_information":[{"code":"Px00030112277","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN","code_information":[{"code":"Px00030112287","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD CDM","code_information":[{"code":"Px00030112289","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSTEOCALCIN BONE G1A PROTEIN LAB","code_information":[{"code":"Px00030112291","type":"CDM"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE BINDING AB","code_information":[{"code":"Px00030112297","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY IGF BINDING PROTEIN LAB","code_information":[{"code":"Px00030112302","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACYLCARNITINES QUANT","code_information":[{"code":"Px00030112306","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112310","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG MEXILETINE LAB","code_information":[{"code":"Px00030112313","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE LAB","code_information":[{"code":"Px00030112315","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FLUORIDE","code_information":[{"code":"Px00030112319","type":"CDM"},{"code":"82735","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUCIN SYNOVIAL FLUID ROPES TEST LAB","code_information":[{"code":"Px00030112322","type":"CDM"},{"code":"83872","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM URINE","code_information":[{"code":"Px00030112323","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030112330","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG LEVETIRACETAM","code_information":[{"code":"Px00030112335","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE","code_information":[{"code":"Px00030112336","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY DIPROPYLACETIC ACID FREE","code_information":[{"code":"Px00030112346","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD FATTY ACIDS","code_information":[{"code":"Px00030112349","type":"CDM"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLUCOSIDASE","code_information":[{"code":"Px00030112350","type":"CDM"},{"code":"82963","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED URINE 24HR LAB","code_information":[{"code":"Px00030112353","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENZYME CELL ACTIVITY LAB","code_information":[{"code":"Px00030112361","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE URINE","code_information":[{"code":"Px00030112371","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN SERUM","code_information":[{"code":"Px00030112373","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030112380","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYELOPEROXIDASE AB","code_information":[{"code":"Px00030112391","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMIKACIN","code_information":[{"code":"Px00030112403","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030112474","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MERCURY QUANTITATIVE","code_information":[{"code":"Px00030112476","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOL RECEP AB PNL","code_information":[{"code":"Px00030112480","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-CENTROMERE ANTIBODY","code_information":[{"code":"Px00030112483","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COPPER URINE","code_information":[{"code":"Px00030112492","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREGNANCY-ASSOCIATED PLASMA PROTEIN-A CDM","code_information":[{"code":"Px00030112528","type":"CDM"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URIC ACID BODY FLUID","code_information":[{"code":"Px00030112538","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5 HIAA LAB","code_information":[{"code":"Px00030112542","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030112551","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030112595","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAG IGM AB","code_information":[{"code":"Px00030112606","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM-URINE","code_information":[{"code":"Px00030112607","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112612","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE","code_information":[{"code":"Px00030112625","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE FREE LAB","code_information":[{"code":"Px00030112643","type":"CDM"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030112650","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TEST FOR CHLOROHYDROCARBONS","code_information":[{"code":"Px00030112657","type":"CDM"},{"code":"82441","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"Px00030112662","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE CDM","code_information":[{"code":"Px00030112672","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NICKEL LAB","code_information":[{"code":"Px00030112683","type":"CDM"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY THYROID STIM HORMON","code_information":[{"code":"Px00030112690","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE 24 HR URINE LAB","code_information":[{"code":"Px00030112700","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FSH(FOLLICLE STIMULATE HORMONE)","code_information":[{"code":"Px00030112713","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030112726","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LDH BODY FLUID","code_information":[{"code":"Px00030112736","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PH (BODY FLUID)","code_information":[{"code":"Px00030112756","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE POTASSIUM LAB","code_information":[{"code":"Px00030112760","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN (CSF)","code_information":[{"code":"Px00030112761","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030112775","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC CDM","code_information":[{"code":"Px00030112776","type":"CDM"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN 24 HR URINE LAB","code_information":[{"code":"Px00030112778","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030112797","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYL RECEPT BLOCKING AB","code_information":[{"code":"Px00030112801","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030112848","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112849","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO LAB","code_information":[{"code":"Px00030112854","type":"CDM"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ALANINE AMINO ALT SGPT LAB","code_information":[{"code":"Px00030112857","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINOLEVULINIC ACID DELTA UR","code_information":[{"code":"Px00030112874","type":"CDM"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDION","code_information":[{"code":"Px00030112891","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112898","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP ANTI-GLIADIN IGA LAB","code_information":[{"code":"Px00030112909","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-GLIADIN IGG","code_information":[{"code":"Px00030112910","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARGININE VASOPRESSION HO","code_information":[{"code":"Px00030112917","type":"CDM"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARSENIC LEVEL URINE","code_information":[{"code":"Px00030112921","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030112931","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030112932","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY C-D TRANSFER MEASURE","code_information":[{"code":"Px00030112938","type":"CDM"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CITRATE LAB","code_information":[{"code":"Px00030112939","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CORTICOSTERONE","code_information":[{"code":"Px00030112955","type":"CDM"},{"code":"82528","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FECES FOR TRYPSIN","code_information":[{"code":"Px00030112972","type":"CDM"},{"code":"84490","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT LAB","code_information":[{"code":"Px00030112998","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030113011","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030113025","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY","code_information":[{"code":"Px00030113031","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BUPROPION","code_information":[{"code":"Px00030113054","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM LEVEL URINE","code_information":[{"code":"Px00030113056","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL CDM","code_information":[{"code":"Px00030113073","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN CDM","code_information":[{"code":"Px00030113075","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030113079","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN CARBON MONO","code_information":[{"code":"Px00030113083","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CC BLOOD GAS SATURATION","code_information":[{"code":"Px00030113091","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030113097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE","code_information":[{"code":"Px00030113107","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARBON DIOXIDE BICARBONATE LAB","code_information":[{"code":"Px00030113128","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL SALIVA","code_information":[{"code":"Px00030113148","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL SUPPRESSION","code_information":[{"code":"Px00030113150","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATINE URINE","code_information":[{"code":"Px00030113162","type":"CDM"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE RANDOM LAB","code_information":[{"code":"Px00030113166","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE CROSSLINK (CTXAR)","code_information":[{"code":"Px00030113181","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00030113288","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP","code_information":[{"code":"Px00030113289","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD W/ DIRECT MEASURE 02 SATURATION CDM","code_information":[{"code":"Px00030113346","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","code_information":[{"code":"Px00030113377","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030113400","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES LAB","code_information":[{"code":"Px00030113413","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN CHROMOTOGRAPHY A2","code_information":[{"code":"Px00030113418","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","code_information":[{"code":"Px00030113445","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE URINE LAB","code_information":[{"code":"Px00030113448","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HISTONE AB IGG","code_information":[{"code":"Px00030113450","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030113461","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HYALURONIC ACID LAB","code_information":[{"code":"Px00030113465","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030113474","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030113488","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNO FOR ANALYTE OTHER THAN INF","code_information":[{"code":"Px00030113490","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE NOS","code_information":[{"code":"Px00030113491","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030113492","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY NON-RIA","code_information":[{"code":"Px00030113496","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030113497","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030113501","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030113503","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030113510","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030113513","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOSASSAY RIA","code_information":[{"code":"Px00030113518","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030113530","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030113541","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEAD - URINE","code_information":[{"code":"Px00030113560","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LUTENIZING HORMONE","code_information":[{"code":"Px00030113579","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030113587","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM LAB","code_information":[{"code":"Px00030113589","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MANGANESE BLOOD LAB","code_information":[{"code":"Px00030113594","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES-TOTAL (24HR U)","code_information":[{"code":"Px00030113625","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC METHEMOGLOBIN","code_information":[{"code":"Px00030113627","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MISC CHEMISTRY MANUAL CHARGE","code_information":[{"code":"Px00030113643","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA LAB","code_information":[{"code":"Px00030113659","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM","code_information":[{"code":"Px00030113660","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OLIGOCL BANDS CSF/SERUM (OLIGB)","code_information":[{"code":"Px00030113718","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030113740","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC RANDOM URINE LAB","code_information":[{"code":"Px00030113752","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030113766","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030113770","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION LAB","code_information":[{"code":"Px00030113772","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE POTASSIUM LAB","code_information":[{"code":"Px00030113785","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030113792","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROSTATIC SPECIFIC AG","code_information":[{"code":"Px00030113800","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030113814","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030113853","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG IBUPROFEN LAB","code_information":[{"code":"Px00030113866","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG COMPLEX DRUG ANALYSIS","code_information":[{"code":"Px00030113870","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030113895","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030113896","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES LAB","code_information":[{"code":"Px00030113913","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030113934","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT ADENOSNE DEAMINASE BODY FL","code_information":[{"code":"Px00030113937","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030113941","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED LAB","code_information":[{"code":"Px00030113956","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030113966","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030113967","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE LAB","code_information":[{"code":"Px00030113975","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030113977","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METALS QT EACH","code_information":[{"code":"Px00030113979","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NESLAB","code_information":[{"code":"Px00030113980","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","code_information":[{"code":"Px00030113983","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF NEPHELOMETRY EACH ANALYTE NES LAB","code_information":[{"code":"Px00030114061","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RNA POLYMERASE III AB IGG","code_information":[{"code":"Px00030114075","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SODIUM (STOOL)","code_information":[{"code":"Px00030114090","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SULFATE URINE LAB","code_information":[{"code":"Px00030114121","type":"CDM"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSERONE","code_information":[{"code":"Px00030114146","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE -TOTAL","code_information":[{"code":"Px00030114149","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030114160","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULT STEP TISSUE TRANSGLUT AB IGG LAB","code_information":[{"code":"Px00030114175","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030114183","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"Px00030114220","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE","code_information":[{"code":"Px00030114229","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE CDM","code_information":[{"code":"Px00030114230","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UROPORPHYRINOGEN-1-SYNTHETASE","code_information":[{"code":"Px00030114243","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VITAMIN D 25 HYDROXY PEDIATRIC","code_information":[{"code":"Px00030114258","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2 ACETAMINOPHEN","code_information":[{"code":"Px00030114302","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 DESIPRAMINE","code_information":[{"code":"Px00030114304","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 AMITRIPTYLINE LAB","code_information":[{"code":"Px00030114306","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 DOXEPINE","code_information":[{"code":"Px00030114307","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BENZODIAZEPINES1-12 ALPRAZOLAM","code_information":[{"code":"Px00030114309","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","code_information":[{"code":"Px00030114312","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OPIATES","code_information":[{"code":"Px00030114313","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALCOHOL URINE RANDOM SCREEN","code_information":[{"code":"Px00030114330","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG CONFIRMATION MEPERIDINE","code_information":[{"code":"Px00030114334","type":"CDM"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 CLONAZEPAM","code_information":[{"code":"Px00030114337","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANXENE (CLORAZEPATE)","code_information":[{"code":"Px00030114340","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF DESIPRAMINE","code_information":[{"code":"Px00030114341","type":"CDM"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030114345","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BARBITURATES","code_information":[{"code":"Px00030114348","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ETHYL GLUCORON/SULF LCMS (ETGA)","code_information":[{"code":"Px00030114351","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF METHADONE","code_information":[{"code":"Px00030114352","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FENTANYL AND METABOLITE SCREEN","code_information":[{"code":"Px00030114355","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030114357","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"Px00030114374","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030114381","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR BENZODIAZEPINE PER DOS LAB","code_information":[{"code":"Px00030114386","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR COCAINE PER DOS LAB","code_information":[{"code":"Px00030114388","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR CORDSTAT PER DOS","code_information":[{"code":"Px00030114389","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ETHYLGLCURONIDE PER DOS","code_information":[{"code":"Px00030114390","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR METH PER DOS LAB","code_information":[{"code":"Px00030114392","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114393","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR NICOTINE PER DOS LAB","code_information":[{"code":"Px00030114394","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR OPIATES URINE PER DOS LAB","code_information":[{"code":"Px00030114399","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR OPIATES PER DOS","code_information":[{"code":"Px00030114400","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114401","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PROPOXY PER DOS LAB","code_information":[{"code":"Px00030114402","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB","code_information":[{"code":"Px00030114403","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR THC URINE PER DOS LAB","code_information":[{"code":"Px00030114404","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR TRICYCLICS PER DOS LAB","code_information":[{"code":"Px00030114406","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE BIOAVAILABLE","code_information":[{"code":"Px00030114407","type":"CDM"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL URINE PER DOS","code_information":[{"code":"Px00030114412","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS PANEL 10-50 LAB","code_information":[{"code":"Px00030114413","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200011","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200012","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200013","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200014","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200015","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200016","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200017","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030200018","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200019","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200020","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200021","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200030","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200060","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY INFLUENZA VIRUS LAB","code_information":[{"code":"Px00030200061","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200078","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200079","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200080","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI LAB","code_information":[{"code":"Px00030200089","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200090","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200108","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200109","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200110","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200111","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200113","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200114","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA LAB","code_information":[{"code":"Px00030200115","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA LAB","code_information":[{"code":"Px00030200116","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200117","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS","code_information":[{"code":"Px00030200118","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030200119","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A","code_information":[{"code":"Px00030200120","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200123","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200124","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200125","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200126","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200127","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200131","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200132","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200133","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200135","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200137","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200138","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200139","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200140","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA LAB","code_information":[{"code":"Px00030200141","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200142","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200143","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES","code_information":[{"code":"Px00030200144","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030200146","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200147","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200148","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200152","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200153","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES LAB","code_information":[{"code":"Px00030200154","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19 IGG LAB","code_information":[{"code":"Px00030200183","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORDETELLA LAB","code_information":[{"code":"Px00030200194","type":"CDM"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200195","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200196","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIV","code_information":[{"code":"Px00030200197","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA LAB","code_information":[{"code":"Px00030200198","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER","code_information":[{"code":"Px00030200199","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH","code_information":[{"code":"Px00030200235","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS","code_information":[{"code":"Px00030200236","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT","code_information":[{"code":"Px00030200237","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200238","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200239","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA","code_information":[{"code":"Px00030200240","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA","code_information":[{"code":"Px00030200242","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA LAB","code_information":[{"code":"Px00030200246","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA LAB","code_information":[{"code":"Px00030200247","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA LAB","code_information":[{"code":"Px00030200251","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200252","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200253","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200267","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030200268","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB LAB","code_information":[{"code":"Px00030200275","type":"CDM"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB LAB","code_information":[{"code":"Px00030200279","type":"CDM"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200287","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200288","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200290","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200291","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200292","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200295","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200296","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200297","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200299","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200300","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200301","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 ANTIBODY FLOW CYTOMETRY EACH LAB","code_information":[{"code":"Px00030200303","type":"CDM"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 ANTIBODY ELISA LAB","code_information":[{"code":"Px00030200304","type":"CDM"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200309","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200310","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200311","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200313","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200314","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH LAB","code_information":[{"code":"Px00030200319","type":"CDM"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200320","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200321","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200322","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200345","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200346","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200350","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200351","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200352","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200353","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200354","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200355","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200356","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200358","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200359","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA LAB","code_information":[{"code":"Px00030200360","type":"CDM"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AQUAPORIN-4 ANTIBODY FLOW CYTOMETRY EACH LAB","code_information":[{"code":"Px00030200361","type":"CDM"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH","code_information":[{"code":"Px00030200362","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200363","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200365","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200366","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200380","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200381","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BLASTOMYCES LAB","code_information":[{"code":"Px00030200382","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200384","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200385","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200391","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200392","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200393","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200394","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PROTOZOA NES LAB","code_information":[{"code":"Px00030200398","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB","code_information":[{"code":"Px00030200407","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200408","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200409","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200414","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUANT LAB","code_information":[{"code":"Px00030200428","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200429","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200452","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200453","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200463","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200464","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200465","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200466","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTICARDIOLIPIN AB PANEL IMMUNOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030200469","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200489","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200492","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH","code_information":[{"code":"Px00030200493","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200494","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200496","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200498","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200499","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200500","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200501","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200502","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200504","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200505","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200506","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200507","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200508","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200509","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200510","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200511","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200512","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-PHOSPHATIDYLSERINE ANTIBODY LAB","code_information":[{"code":"Px00030200513","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200514","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200515","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200516","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200517","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200518","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200519","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200520","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200521","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200522","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200523","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200526","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200527","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS","code_information":[{"code":"Px00030200529","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200530","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200532","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200533","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200534","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200535","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200536","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200537","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200538","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200539","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200540","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200541","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200542","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200543","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030200544","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200545","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HTLV-I LAB","code_information":[{"code":"Px00030200548","type":"CDM"},{"code":"86687","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HTLV-II LAB","code_information":[{"code":"Px00030200549","type":"CDM"},{"code":"86688","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HEP DELTA AGENT LAB","code_information":[{"code":"Px00030200550","type":"CDM"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 LAB","code_information":[{"code":"Px00030200551","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 LAB","code_information":[{"code":"Px00030200552","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200553","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200554","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PROTOZOA NES LAB","code_information":[{"code":"Px00030200556","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030200557","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200558","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200559","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200560","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200561","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200562","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200563","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200564","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200568","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200569","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200570","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200571","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200572","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200573","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200574","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200575","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BRUCELLA LAB","code_information":[{"code":"Px00030200576","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200577","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200578","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200579","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200581","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200582","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200583","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA LAB","code_information":[{"code":"Px00030200584","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200585","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200586","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200587","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200588","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200589","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030200590","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BRUCELLA LAB","code_information":[{"code":"Px00030200591","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030200592","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030200593","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200594","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200595","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200596","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200597","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS LAB","code_information":[{"code":"Px00030200598","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS LAB","code_information":[{"code":"Px00030200599","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HC COMPLEMENT ANTIGEN EACH COMPONENT LAB CDM","code_information":[{"code":"Px00030200600","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030200601","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY","code_information":[{"code":"Px00030200602","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED CDM","code_information":[{"code":"Px00030200603","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB LAB","code_information":[{"code":"Px00030200604","type":"CDM"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200605","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200606","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200607","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200608","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200609","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200612","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200613","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200614","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST LAB","code_information":[{"code":"Px00030200615","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200618","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE LAB","code_information":[{"code":"Px00030200629","type":"CDM"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENCEPHALITIS EASTERN EQUINE LAB","code_information":[{"code":"Px00030200630","type":"CDM"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENCEPHALITIS ST. LOUIS LAB","code_information":[{"code":"Px00030200631","type":"CDM"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENCEPHALITIS WESTRN EQUINE LAB","code_information":[{"code":"Px00030200632","type":"CDM"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200637","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA LAB","code_information":[{"code":"Px00030200641","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200644","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200645","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030200649","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN LAB","code_information":[{"code":"Px00030200650","type":"CDM"},{"code":"86005","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY YERSINIA","code_information":[{"code":"Px00030200651","type":"CDM"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200652","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200655","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200656","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200657","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH","code_information":[{"code":"Px00030200658","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200668","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200669","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200670","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200671","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200672","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200673","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200675","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200676","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200677","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200678","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":814.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200679","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":895.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200680","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","code_information":[{"code":"Px00030200681","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200682","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200683","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200684","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200685","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200686","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200687","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200688","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"Px00030200689","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA","code_information":[{"code":"Px00030200690","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA LAB","code_information":[{"code":"Px00030200691","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200692","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA LAB","code_information":[{"code":"Px00030200694","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES SCREEN LAB","code_information":[{"code":"Px00030200716","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200720","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200721","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200722","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200723","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200724","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200725","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030200728","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200730","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200731","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200732","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200733","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200734","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200735","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY LAB","code_information":[{"code":"Px00030200748","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200768","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200769","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200773","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200821","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200822","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR MODLG ANTB LAB","code_information":[{"code":"Px00030200823","type":"CDM"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUSCLE-SPECIFIC KINASE ANTB LAB","code_information":[{"code":"Px00030200824","type":"CDM"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200825","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200826","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR MODLG ANTB LAB","code_information":[{"code":"Px00030200827","type":"CDM"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200828","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200832","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200833","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR MODLG ANTB LAB","code_information":[{"code":"Px00030200834","type":"CDM"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200842","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200843","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER ANTI-MITOCHONDRIAL AB LAB","code_information":[{"code":"Px00030210003","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST QUANTITATIVE","code_information":[{"code":"Px00030210017","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA ADENOVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030210027","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030210035","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA LAB","code_information":[{"code":"Px00030210036","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EAE LAB","code_information":[{"code":"Px00030210044","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030210064","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-PROTEINASE 3 ANTIBODY","code_information":[{"code":"Px00030210079","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELECTROPHORESIS CSF (AKA 84166)","code_information":[{"code":"Px00030210083","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL (M2) AB IGG","code_information":[{"code":"Px00030210093","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGG CSF","code_information":[{"code":"Px00030210100","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC F-ACTIN (SMOOTH MUSCLE) AB IGG","code_information":[{"code":"Px00030210102","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA LAB","code_information":[{"code":"Px00030210107","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY NON-ANTIBODY","code_information":[{"code":"Px00030210110","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210144","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030210148","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY LAB","code_information":[{"code":"Px00030210169","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY","code_information":[{"code":"Px00030210186","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY","code_information":[{"code":"Px00030210187","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA LAB","code_information":[{"code":"Px00030210188","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY","code_information":[{"code":"Px00030210189","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-1 LAB","code_information":[{"code":"Px00030210190","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-2 LAB","code_information":[{"code":"Px00030210191","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030210193","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030210194","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210195","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM LAB","code_information":[{"code":"Px00030210200","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES LAB","code_information":[{"code":"Px00030210201","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030210202","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210204","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030210205","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FIXATION TESTS EACH ANTIGEN LAB","code_information":[{"code":"Px00030210206","type":"CDM"},{"code":"86171","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210211","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":26.0,"discounted_cash":18.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030210218","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030210226","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","code_information":[{"code":"Px00030210230","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY LAB","code_information":[{"code":"Px00030210231","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030210237","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SARS COV-2 IMMUNE RESPONSE IGM","code_information":[{"code":"Px00030210242","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030210243","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210247","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210248","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210249","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210250","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210252","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210253","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210254","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210255","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210256","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY LEGIONELLA LAB","code_information":[{"code":"Px00030210257","type":"CDM"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030210267","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030210268","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030210269","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA LAB","code_information":[{"code":"Px00030210285","type":"CDM"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030210292","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE","code_information":[{"code":"Px00030210302","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - IGE ALLERGEN","code_information":[{"code":"Px00030210309","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSA (RO) QUANTITATIVE","code_information":[{"code":"Px00030210311","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSB (LA) QUANTITATIVE","code_information":[{"code":"Px00030210312","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ADSORPTION","code_information":[{"code":"Px00030210315","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIBODY IDENT PANEL","code_information":[{"code":"Px00030210316","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIBODY SCREEN","code_information":[{"code":"Px00030210317","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN","code_information":[{"code":"Px00030210319","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ELUTION","code_information":[{"code":"Px00030210322","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC ENZYME PRETREAT","code_information":[{"code":"Px00030210323","type":"CDM"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC PHENOTYPE(NOT RH)","code_information":[{"code":"Px00030210326","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BARTONELLA ANTIBODY","code_information":[{"code":"Px00030210339","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW","code_information":[{"code":"Px00030210345","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN","code_information":[{"code":"Px00030210346","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HSV 2 ANTIBODY IGG","code_information":[{"code":"Px00030210349","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM CDM","code_information":[{"code":"Px00030210350","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT X 1LAB","code_information":[{"code":"Px00030210352","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER","code_information":[{"code":"Px00030210354","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030210360","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030210361","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - ALLERGEN SPEC","code_information":[{"code":"Px00030210362","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES - ANA","code_information":[{"code":"Px00030210369","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA CDM","code_information":[{"code":"Px00030210374","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT X 33LAB","code_information":[{"code":"Px00030210380","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030210382","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030210383","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030210394","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUMPS ANTIBODY IGG","code_information":[{"code":"Px00030210401","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN ANTIBODY - IGA","code_information":[{"code":"Px00030210404","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY","code_information":[{"code":"Px00030210405","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA IGM LAB","code_information":[{"code":"Px00030210406","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY - AB IGG","code_information":[{"code":"Px00030210407","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS CDM","code_information":[{"code":"Px00030210408","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210409","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210410","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY - IGA","code_information":[{"code":"Px00030210412","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY - AB","code_information":[{"code":"Px00030210413","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210414","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY AB","code_information":[{"code":"Px00030210415","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT TOTAL HEMOLYTIC CDM","code_information":[{"code":"Px00030210418","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID ANTIBODY","code_information":[{"code":"Px00030210419","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-PHOSPHATIDYLSERINE ANTIBODY CDM","code_information":[{"code":"Px00030210420","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ SCREEN","code_information":[{"code":"Px00030210423","type":"CDM"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ TITER CDM","code_information":[{"code":"Px00030210424","type":"CDM"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030210428","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN - C3","code_information":[{"code":"Px00030210429","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN - C4","code_information":[{"code":"Px00030210430","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-DNA QUANTITATIVE","code_information":[{"code":"Px00030210432","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR QUAL","code_information":[{"code":"Px00030210433","type":"CDM"},{"code":"86294","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN","code_information":[{"code":"Px00030210459","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY","code_information":[{"code":"Px00030210468","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030210470","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSDNA QUANTITATIVE","code_information":[{"code":"Px00030210473","type":"CDM"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030210481","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SM RNP","code_information":[{"code":"Px00030210486","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSA","code_information":[{"code":"Px00030210487","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE","code_information":[{"code":"Px00030210497","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030210516","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210518","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT","code_information":[{"code":"Px00030210522","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SCL 70","code_information":[{"code":"Px00030210527","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - JO 1","code_information":[{"code":"Px00030210528","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSB","code_information":[{"code":"Px00030210534","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY","code_information":[{"code":"Px00030210537","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT - INFLUENZA","code_information":[{"code":"Px00030210554","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRINSIC FACTOR ANTIBODIES CDM","code_information":[{"code":"Px00030210572","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEUTRALIZATION TEST VIRAL","code_information":[{"code":"Px00030210575","type":"CDM"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"Px00030210590","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM","code_information":[{"code":"Px00030210608","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS ANTIBODY","code_information":[{"code":"Px00030210616","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030210621","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS ANTIBODY LAB","code_information":[{"code":"Px00030210622","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BRUCELLA CDM","code_information":[{"code":"Px00030210627","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRUCELLA ANTIBODY-SEROLOGY AB","code_information":[{"code":"Px00030210630","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CHLAMYDIA LAB","code_information":[{"code":"Px00030210636","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA IGM ANTIBODY - PNEUMONIAE IGM","code_information":[{"code":"Px00030210646","type":"CDM"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COCCIDIOIDES ANTIBODY","code_information":[{"code":"Px00030210650","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COCCIDIOIDES ANTIBODY - FUNGAL","code_information":[{"code":"Px00030210653","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00030210657","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS CDM","code_information":[{"code":"Px00030210665","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS CDM","code_information":[{"code":"Px00030210666","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS ANTIBODY - POLIOVIRUS TYPE 2","code_information":[{"code":"Px00030210681","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS CDM","code_information":[{"code":"Px00030210686","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COXSACKIE B ANTIBODY","code_information":[{"code":"Px00030210694","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ENTEROVIRUS LAB","code_information":[{"code":"Px00030210703","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS ANTIBODY ANTIBODY ENTEROVIRUS","code_information":[{"code":"Px00030210705","type":"CDM"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ANTIBODY","code_information":[{"code":"Px00030210707","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210708","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS S CEREVISIAE IGA LAB","code_information":[{"code":"Px00030210710","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS S CEREVISIAE IGG LAB","code_information":[{"code":"Px00030210711","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE","code_information":[{"code":"Px00030210717","type":"CDM"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUMPS VIRUS AB IGM (ARUP)","code_information":[{"code":"Px00030210740","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210744","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210745","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210747","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTOZOA ANTIBODY NOS","code_information":[{"code":"Px00030210750","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA CDM","code_information":[{"code":"Px00030210757","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA","code_information":[{"code":"Px00030210764","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210765","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210767","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210769","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS IGM CDM","code_information":[{"code":"Px00030210773","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210775","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210776","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WEST NILE AB IGG CSF(PANL)","code_information":[{"code":"Px00030210777","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - HERPESVIRUS 6 AB","code_information":[{"code":"Px00030210784","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS DENGUE","code_information":[{"code":"Px00030210785","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HANTAVIRUS CDM","code_information":[{"code":"Px00030210786","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030210788","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HEP E IGG","code_information":[{"code":"Px00030210793","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - HTLV-1","code_information":[{"code":"Px00030210794","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - HHV-6","code_information":[{"code":"Px00030210795","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030210823","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":814.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030210824","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":895.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210833","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D)","code_information":[{"code":"Px00030210857","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC RH PHENOTYPE","code_information":[{"code":"Px00030210863","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS AG EIA","code_information":[{"code":"Px00030210891","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - QUANT","code_information":[{"code":"Px00030210901","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - IGE QUANT","code_information":[{"code":"Px00030210904","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210913","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210916","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210917","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTIFERON TB GOLD","code_information":[{"code":"Px00030210934","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL RPR","code_information":[{"code":"Px00030210936","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUANT","code_information":[{"code":"Px00030210938","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WEST NILE AB IGM CSF (PANL)","code_information":[{"code":"Px00030210947","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH","code_information":[{"code":"Px00030210955","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARC CELL TREAT-CHEM","code_information":[{"code":"Px00030210957","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030210977","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS LAB","code_information":[{"code":"Px00030210978","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY LEGIONELLA LAB","code_information":[{"code":"Px00030210981","type":"CDM"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CMV PCR QUALITATIVE","code_information":[{"code":"Px00030210986","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTOMEGALOVIRUS QUANT PCR(ARUP)","code_information":[{"code":"Px00030210994","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DETECT AGENT NOS-RNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210996","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS PCR","code_information":[{"code":"Px00030211001","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030211006","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEP C PCR (QUAL)","code_information":[{"code":"Px00030211012","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C GENOTYPING","code_information":[{"code":"Px00030211015","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX PCR","code_information":[{"code":"Px00030211017","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 REV TRNSCRPT CDM","code_information":[{"code":"Px00030211018","type":"CDM"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":798.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIV ULTRA SENSITIVE PCR","code_information":[{"code":"Px00030211020","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIUM TB PCR","code_information":[{"code":"Px00030211051","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA PCR","code_information":[{"code":"Px00030211052","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION SERUM","code_information":[{"code":"Px00030211078","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI - IGG","code_information":[{"code":"Px00030211084","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 LAB","code_information":[{"code":"Px00030211085","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA ANTIBODY - IGG","code_information":[{"code":"Px00030211086","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEP C AB TEST CONFIRM","code_information":[{"code":"Px00030211089","type":"CDM"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211104","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211109","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW","code_information":[{"code":"Px00030211115","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030211124","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - STREPTOZYME TITER","code_information":[{"code":"Px00030211128","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY -AB TO EARLY D AG","code_information":[{"code":"Px00030211130","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - ANTI-PARIETAL","code_information":[{"code":"Px00030211131","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RNP","code_information":[{"code":"Px00030211132","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUBEOLA ANTIBODY - IGG","code_information":[{"code":"Px00030211133","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN PURKINJE CELL","code_information":[{"code":"Px00030211134","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ENA SMITH","code_information":[{"code":"Px00030211136","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA ANTIBODY-PSITTACHI","code_information":[{"code":"Px00030211137","type":"CDM"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030211146","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030211154","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030211155","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030211166","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030211167","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030211170","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030211172","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY IGG/IGM MULTI STEP PROCESS LAB","code_information":[{"code":"Px00030211173","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19","code_information":[{"code":"Px00030211175","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211176","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211177","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211178","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BLASTOMYCES LAB","code_information":[{"code":"Px00030211179","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA LAB","code_information":[{"code":"Px00030211180","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030211181","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA LAB","code_information":[{"code":"Px00030211182","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030211229","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211230","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211234","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030211235","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211236","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT","code_information":[{"code":"Px00030211258","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY LAB","code_information":[{"code":"Px00030211272","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM LAB","code_information":[{"code":"Px00030211296","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00030211518","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RICKETTSIA ANTIBODY-IGG","code_information":[{"code":"Px00030211530","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-PHOSPHATIDYLSERINE ANTIBODY LAB","code_information":[{"code":"Px00030211534","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500004","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500007","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500022","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500023","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500024","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500025","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500026","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500027","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION PLATELET LAB","code_information":[{"code":"Px00030500028","type":"CDM"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA","code_information":[{"code":"Px00030500038","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500053","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL","code_information":[{"code":"Px00030500054","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","code_information":[{"code":"Px00030500055","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA","code_information":[{"code":"Px00030500056","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY LAB","code_information":[{"code":"Px00030500062","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500067","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030500068","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030500069","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED","code_information":[{"code":"Px00030500070","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500077","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH LAB","code_information":[{"code":"Px00030500078","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT LAB","code_information":[{"code":"Px00030500109","type":"CDM"},{"code":"85004","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT LAB","code_information":[{"code":"Px00030500110","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500112","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030500113","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030500126","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500129","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500130","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500131","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500134","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN INHIBITION TISSUE LAB","code_information":[{"code":"Px00030500135","type":"CDM"},{"code":"85705","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500137","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"Px00030500138","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500142","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500144","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500145","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500146","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500150","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500151","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"Px00030500152","type":"CDM"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","code_information":[{"code":"Px00030500153","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500154","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030500156","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030500157","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030500158","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY LAB","code_information":[{"code":"Px00030500159","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500160","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500161","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500162","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500163","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500164","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030500165","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500166","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500168","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500171","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500172","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500173","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ANTIGEN LAB","code_information":[{"code":"Px00030500174","type":"CDM"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030500175","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500176","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH LAB","code_information":[{"code":"Px00030500177","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500178","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500179","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT LEUKOCYTE WBC AUTOMATED LAB","code_information":[{"code":"Px00030500181","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500190","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030500191","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030500194","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500195","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500196","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030500197","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030500198","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500199","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500253","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH LAB","code_information":[{"code":"Px00030510002","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510003","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION","code_information":[{"code":"Px00030510004","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510006","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT LEUKOCYTE WBC AUTOMATED LAB","code_information":[{"code":"Px00030510007","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT CDM","code_information":[{"code":"Px00030510022","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VISCOSITY CDM","code_information":[{"code":"Px00030510035","type":"CDM"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FETAL","code_information":[{"code":"Px00030510036","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ANTIGEN LAB","code_information":[{"code":"Px00030510046","type":"CDM"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN CDM","code_information":[{"code":"Px00030510055","type":"CDM"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPTILASE TEST CDM","code_information":[{"code":"Px00030510056","type":"CDM"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MURAMIDASE CDM","code_information":[{"code":"Px00030510057","type":"CDM"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL 50-50","code_information":[{"code":"Px00030510067","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION PLATELET LAB","code_information":[{"code":"Px00030510070","type":"CDM"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510071","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EUGLOBULIN LYSIS LAB","code_information":[{"code":"Px00030510073","type":"CDM"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY CDM","code_information":[{"code":"Px00030510074","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RBC COUNT","code_information":[{"code":"Px00030510077","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"Px00030510082","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510083","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510086","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510089","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RISTOCETIN COFACTOR","code_information":[{"code":"Px00030510091","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510092","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTITHROMBIN III ANTIGEN ASSAY","code_information":[{"code":"Px00030510135","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510141","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510143","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-THROMBIN III","code_information":[{"code":"Px00030510151","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY CDM","code_information":[{"code":"Px00030510152","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510159","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030510169","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOT FCTR VIII VF FCTR ANTIGEN","code_information":[{"code":"Px00030510174","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRVVT MIX","code_information":[{"code":"Px00030510186","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510207","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA LAB","code_information":[{"code":"Px00030510209","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA","code_information":[{"code":"Px00030510210","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510230","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN S. ACTIVITY","code_information":[{"code":"Px00030510232","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510233","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH LAB","code_information":[{"code":"Px00030510234","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AC PROTIME","code_information":[{"code":"Px00030510236","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH CDM","code_information":[{"code":"Px00030510246","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PTT 1 TO 1 MIX","code_information":[{"code":"Px00030510252","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510253","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030510256","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED LAB","code_information":[{"code":"Px00030510271","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLASMINOGEN (CHROMOGENIC)","code_information":[{"code":"Px00030510273","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION","code_information":[{"code":"Px00030510283","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030510294","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030510296","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP B LAB","code_information":[{"code":"Px00030510311","type":"CDM"},{"code":"87802","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN C ANTIGEN","code_information":[{"code":"Px00030510312","type":"CDM"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN INHIBITION TISSUE","code_information":[{"code":"Px00030510321","type":"CDM"},{"code":"85705","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D LAB","code_information":[{"code":"Px00030510352","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510353","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S TOTAL LAB","code_information":[{"code":"Px00030510354","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510355","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS SYNOVIAL","code_information":[{"code":"Px00030510410","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FILARIA SMEAR","code_information":[{"code":"Px00030510414","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030510415","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CD4","code_information":[{"code":"Px00030510419","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030510428","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION PLATELET LAB","code_information":[{"code":"Px00030510455","type":"CDM"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510456","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA LAB","code_information":[{"code":"Px00030510464","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS","code_information":[{"code":"Px00030600044","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ENTAMOEBA HISTOLYTICA GRP LAB","code_information":[{"code":"Px00030600058","type":"CDM"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030600083","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600090","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600091","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600092","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600093","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600102","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC LAB","code_information":[{"code":"Px00030600104","type":"CDM"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS QUANTIFICATION LAB","code_information":[{"code":"Px00030600105","type":"CDM"},{"code":"87530","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600106","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB LAB","code_information":[{"code":"Px00030600107","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600108","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600109","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC LAB","code_information":[{"code":"Px00030600111","type":"CDM"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL LAB","code_information":[{"code":"Px00030600138","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","code_information":[{"code":"Px00030600148","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030600150","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600157","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600158","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600159","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600165","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600166","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600167","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600179","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600180","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI LEGIONELLA PNEUMOPHILA LAB","code_information":[{"code":"Px00030600181","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT& OR AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600182","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030600183","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600189","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL LAB","code_information":[{"code":"Px00030600190","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600191","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600228","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600265","type":"CDM"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA GENITALIUM PCR LAB","code_information":[{"code":"Px00030600266","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA GENITALIUM PCR LAB","code_information":[{"code":"Px00030600267","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600268","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS TYPES LAB","code_information":[{"code":"Px00030600269","type":"CDM"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600274","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600275","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600282","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600284","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANTITATIVE URINE LAB","code_information":[{"code":"Px00030600291","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600295","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600296","type":"CDM"},{"code":"87551","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600316","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS PLASMA QUANT PCR LAB","code_information":[{"code":"Px00030600317","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORTHOPOXVIRUS AMP PRB EACH LAB","code_information":[{"code":"Px00030600321","type":"CDM"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADI LEGIONELLA PNEUMOPHILA LAB","code_information":[{"code":"Px00030600328","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600331","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL LAB","code_information":[{"code":"Px00030600332","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600337","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600341","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA BABESIA MICROTI AMPLIFIED PROBE TECHNIQUE","code_information":[{"code":"Px00030600343","type":"CDM"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION LAB","code_information":[{"code":"Px00030600347","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600348","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS QUANTIFICATION EACH ORGANISM LAB","code_information":[{"code":"Px00030600349","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION LAB","code_information":[{"code":"Px00030600350","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS LAB","code_information":[{"code":"Px00030600351","type":"CDM"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS LAB","code_information":[{"code":"Px00030600352","type":"CDM"},{"code":"87903","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":477.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG LAB","code_information":[{"code":"Px00030600353","type":"CDM"},{"code":"87904","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT GEXYP DNA/RNA HIV 1 OTHER REGION LAB","code_information":[{"code":"Px00030600354","type":"CDM"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ LAB","code_information":[{"code":"Px00030600355","type":"CDM"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600358","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL LAB","code_information":[{"code":"Px00030600359","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID LAB","code_information":[{"code":"Px00030600360","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600362","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600363","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600364","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600365","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600366","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600369","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600370","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600371","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600372","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL LAB","code_information":[{"code":"Px00030600373","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION TISSUE CULTURE LAB","code_information":[{"code":"Px00030600375","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600377","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600378","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE LAB","code_information":[{"code":"Px00030600379","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS LAB","code_information":[{"code":"Px00030600382","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS","code_information":[{"code":"Px00030600383","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600388","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600390","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600391","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600392","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600394","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600395","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","code_information":[{"code":"Px00030600396","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600397","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600403","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600404","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600405","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600406","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION LAB","code_information":[{"code":"Px00030600407","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS LAB","code_information":[{"code":"Px00030600408","type":"CDM"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":798.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","code_information":[{"code":"Px00030600409","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600410","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600411","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600414","type":"CDM"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600417","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600418","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600427","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600428","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600429","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600431","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600432","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600433","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600434","type":"CDM"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600435","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE","code_information":[{"code":"Px00030600449","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600458","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL","code_information":[{"code":"Px00030600459","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB","code_information":[{"code":"Px00030600460","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM","code_information":[{"code":"Px00030600461","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL LAB","code_information":[{"code":"Px00030600462","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ LAB","code_information":[{"code":"Px00030600463","type":"CDM"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE","code_information":[{"code":"Px00030600464","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","code_information":[{"code":"Px00030600465","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO INFLUENZA LAB","code_information":[{"code":"Px00030600466","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN LAB","code_information":[{"code":"Px00030600469","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600470","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB LAB","code_information":[{"code":"Px00030600483","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600487","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600607","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600608","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600738","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600749","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600751","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ LAB","code_information":[{"code":"Px00030600758","type":"CDM"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600763","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD LAB","code_information":[{"code":"Px00030610006","type":"CDM"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ADENOVIRUS ENTERIC TYP 40/41 LAB","code_information":[{"code":"Px00030610011","type":"CDM"},{"code":"87301","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEGIONELLA CULTURE","code_information":[{"code":"Px00030610019","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ROTAVIRUS LAB","code_information":[{"code":"Px00030610020","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610027","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610033","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN","code_information":[{"code":"Px00030610046","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610056","type":"CDM"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610061","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610062","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET LAB","code_information":[{"code":"Px00030610063","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS LAB","code_information":[{"code":"Px00030610065","type":"CDM"},{"code":"87905","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030610066","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610067","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610068","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030610069","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID LAB","code_information":[{"code":"Px00030610070","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS LAB","code_information":[{"code":"Px00030610071","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA GIARDIA LAB","code_information":[{"code":"Px00030610072","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610075","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610076","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610077","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 20 TARGET BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610078","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE LAB","code_information":[{"code":"Px00030610087","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE LAB","code_information":[{"code":"Px00030610088","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610089","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT LAB","code_information":[{"code":"Px00030610090","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030610092","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD LAB","code_information":[{"code":"Px00030610095","type":"CDM"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS LAB","code_information":[{"code":"Px00030610096","type":"CDM"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C QUANTITATIVE PCR","code_information":[{"code":"Px00030610103","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610111","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS QUANTIFICATION LAB","code_information":[{"code":"Px00030610112","type":"CDM"},{"code":"87530","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B-DIRECT AG","code_information":[{"code":"Px00030610120","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC N.GONORRHOEAE DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610129","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PARASITE ID","code_information":[{"code":"Px00030610134","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERTUSSIS BY PCR","code_information":[{"code":"Px00030610137","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM","code_information":[{"code":"Px00030610140","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ROTAVIRUS CDM","code_information":[{"code":"Px00030610142","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN CDM","code_information":[{"code":"Px00030610146","type":"CDM"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA/RNA SEQUENCING ISOLATE","code_information":[{"code":"Px00030610170","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610192","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610195","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM LAB","code_information":[{"code":"Px00030610199","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610200","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610201","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610218","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610219","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030610220","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610221","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610222","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610231","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610232","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030610233","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030610234","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610235","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED","code_information":[{"code":"Px00030610240","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION TISSUE CULTURE LAB","code_information":[{"code":"Px00030610253","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030610254","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030610255","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION TISSUE CULTURE LAB","code_information":[{"code":"Px00030610256","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610257","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610258","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610259","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION","code_information":[{"code":"Px00030610268","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ADENOVIRUS ENTERIC TYP 40/41","code_information":[{"code":"Px00030610281","type":"CDM"},{"code":"87301","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD CULTURE FOR BACTERIA","code_information":[{"code":"Px00030610301","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELLLAB","code_information":[{"code":"Px00030610303","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL CDM","code_information":[{"code":"Px00030610304","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA CDM","code_information":[{"code":"Px00030610308","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA CDM","code_information":[{"code":"Px00030610309","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - LOWER RESPIR","code_information":[{"code":"Px00030610313","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030610315","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER","code_information":[{"code":"Px00030610321","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - WOUND","code_information":[{"code":"Px00030610335","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - MISC/OTHER/ROUTINE","code_information":[{"code":"Px00030610340","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610356","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE ANAEROBE IDENT EACH - ANAEROBIC ID","code_information":[{"code":"Px00030610357","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610359","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL LAB","code_information":[{"code":"Px00030610361","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL CDM","code_information":[{"code":"Px00030610362","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE AEROBIC IDENTIFY","code_information":[{"code":"Px00030610363","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE AEROBIC IDENTIFY - BACTERIAL ID PAML","code_information":[{"code":"Px00030610364","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610380","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610389","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - MRSA /MSSA","code_information":[{"code":"Px00030610391","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610392","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - BETA STREP SCREEN","code_information":[{"code":"Px00030610398","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610401","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030610410","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE CULTURE/COLONY COUNT","code_information":[{"code":"Px00030610417","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL","code_information":[{"code":"Px00030610420","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ISOLATION CULTURE - YEAST","code_information":[{"code":"Px00030610421","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ISOLATION CULTURE","code_information":[{"code":"Px00030610423","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030610426","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD CDM","code_information":[{"code":"Px00030610432","type":"CDM"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610436","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","code_information":[{"code":"Px00030610444","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE","code_information":[{"code":"Px00030610448","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE_1","code_information":[{"code":"Px00030610449","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030610463","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION","code_information":[{"code":"Px00030610472","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MACROSCOPIC EXAM ARTHROPOD","code_information":[{"code":"Px00030610475","type":"CDM"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PINWORM EXAMINATION CDM","code_information":[{"code":"Px00030610477","type":"CDM"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE HOMOGENIZATION CULTR - FOR CULTURE","code_information":[{"code":"Px00030610479","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030610483","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","code_information":[{"code":"Px00030610491","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030610494","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610504","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030610507","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPTIBLE MIC - MIF FUNGUS","code_information":[{"code":"Px00030610508","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1915.0,"discounted_cash":1340.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPTIBLE MIC -FUNG 4-DRUGS","code_information":[{"code":"Px00030610511","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPTIBLE MIC - SUSCEPT","code_information":[{"code":"Px00030610514","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":574.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPTIBLE MIC BACTERIAL MIC","code_information":[{"code":"Px00030610541","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610547","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"Px00030610566","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM AG EIA","code_information":[{"code":"Px00030610581","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA INFLUENZA A/B EACH CDM","code_information":[{"code":"Px00030610591","type":"CDM"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONC","code_information":[{"code":"Px00030610599","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL AB IGG","code_information":[{"code":"Px00030610601","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE STOOL ADDITIONAL PATH","code_information":[{"code":"Px00030610606","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR","code_information":[{"code":"Px00030610616","type":"CDM"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-HAIR NAIL SKIN","code_information":[{"code":"Px00030610637","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE AFB BLOOD LAB","code_information":[{"code":"Px00030610646","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"Px00030610647","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AFB STAIN","code_information":[{"code":"Px00030610665","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030610666","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCOFLUOR STAIN","code_information":[{"code":"Px00030610672","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610674","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CMV AMPLIFIED PROBE","code_information":[{"code":"Px00030610679","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"Px00030610682","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610693","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 OTHER REGION LAB","code_information":[{"code":"Px00030610695","type":"CDM"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION LAB","code_information":[{"code":"Px00030610698","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 CDM","code_information":[{"code":"Px00030610702","type":"CDM"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 CDM","code_information":[{"code":"Px00030610703","type":"CDM"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE LAB","code_information":[{"code":"Px00030610722","type":"CDM"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL","code_information":[{"code":"Px00030610723","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT","code_information":[{"code":"Px00030610724","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA LAB","code_information":[{"code":"Px00030610751","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN LAB","code_information":[{"code":"Px00030610752","type":"CDM"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","code_information":[{"code":"Px00030610770","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA LAB","code_information":[{"code":"Px00030610803","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE","code_information":[{"code":"Px00030610809","type":"CDM"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA PROBE TYPE 12-25","code_information":[{"code":"Px00030610971","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700009","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700011","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY","code_information":[{"code":"Px00030700012","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUALITATIVE CDM","code_information":[{"code":"Px00030710011","type":"CDM"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES","code_information":[{"code":"Px00030710013","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP LAB","code_information":[{"code":"Px00030910017","type":"CDM"},{"code":"81383","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MLH1 GENE FULL SEQUENCE","code_information":[{"code":"Px00030910023","type":"CDM"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":2226.0,"discounted_cash":1558.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MLH1 GENE DUP/DELETE VARIANT","code_information":[{"code":"Px00030910024","type":"CDM"},{"code":"81294","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":925.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PMS2 GENE FULL DEQ ANALYSIS","code_information":[{"code":"Px00030910025","type":"CDM"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.0,"discounted_cash":1525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PMS2 GENE DUP/DELETE VARIANT","code_information":[{"code":"Px00030910026","type":"CDM"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":925.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MSH2 GENE FULL SEQUENCE","code_information":[{"code":"Px00030910027","type":"CDM"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MSH2 GENE DUP/DELETE VARIANT","code_information":[{"code":"Px00030910028","type":"CDM"},{"code":"81297","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MSH6 GENE FULL SEQUENCE","code_information":[{"code":"Px00030910029","type":"CDM"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1811.0,"discounted_cash":1267.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MSH6 GENE DUP/DELETE VARIANT","code_information":[{"code":"Px00030910030","type":"CDM"},{"code":"81300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROCEDURE LEVEL 9","code_information":[{"code":"Px00030910032","type":"CDM"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.0,"discounted_cash":1948.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 CDM","code_information":[{"code":"Px00030910201","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031000038","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT LAB","code_information":[{"code":"Px00031000042","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000045","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000047","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000048","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00031000060","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031000072","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS","code_information":[{"code":"Px00031000077","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS","code_information":[{"code":"Px00031000092","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000107","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEXA GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000134","type":"CDM"},{"code":"81255","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT CDM","code_information":[{"code":"Px00031000163","type":"CDM"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00031000166","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000167","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000168","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR LAB","code_information":[{"code":"Px00031000180","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00031000181","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00031000182","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR LAB","code_information":[{"code":"Px00031000195","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GJB2 GENE ANALYSIS FULL GENE SEQUENCE LAB","code_information":[{"code":"Px00031000204","type":"CDM"},{"code":"81252","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS LAB","code_information":[{"code":"Px00031000205","type":"CDM"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SERPINA1 GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000206","type":"CDM"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 LAB","code_information":[{"code":"Px00031000207","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 LAB","code_information":[{"code":"Px00031000208","type":"CDM"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 LAB","code_information":[{"code":"Px00031000209","type":"CDM"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000210","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00031000211","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000212","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) LAB","code_information":[{"code":"Px00031000213","type":"CDM"},{"code":"81276","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00031000214","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000215","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000216","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":337.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000217","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB LAB","code_information":[{"code":"Px00031000218","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLMYD&GONORR AMP PRB","code_information":[{"code":"Px00031000220","type":"CDM"},{"code":"0353U","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MGMT METHYLATION ANALYSIS LAB","code_information":[{"code":"Px00031000224","type":"CDM"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICRODISSECTION PREP IDENTIFIED TARGET MANUAL LAB","code_information":[{"code":"Px00031000225","type":"CDM"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":780.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN LAB","code_information":[{"code":"Px00031000239","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN LAB","code_information":[{"code":"Px00031000240","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031000241","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031000242","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL MICRODELTJ GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031000243","type":"CDM"},{"code":"81422","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DPYD GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000263","type":"CDM"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT DS BV&VAGINITIS DNA ALG LAB","code_information":[{"code":"Px00031000363","type":"CDM"},{"code":"81515","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCULUS QUANTITATIVE CHEMICAL LAB","code_information":[{"code":"Px00031010048","type":"CDM"},{"code":"82360","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROSTATE BIOPSY ANY MTHD LAB","code_information":[{"code":"Px00031010110","type":"CDM"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA CDM","code_information":[{"code":"Px00031010138","type":"CDM"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROCEDURE LEVEL 6","code_information":[{"code":"Px00031010140","type":"CDM"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IDH1 COMMON VARIANTS","code_information":[{"code":"Px00031010148","type":"CDM"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IDH2 COMMON VARIANTS","code_information":[{"code":"Px00031010149","type":"CDM"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DPYD GENE COMMON VARIANTS","code_information":[{"code":"Px00031010154","type":"CDM"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":760.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HBB GENE KNOWN FAM VARIANT","code_information":[{"code":"Px00031010168","type":"CDM"},{"code":"81362","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BILL SURG SLIDE PREP","code_information":[{"code":"Px00031010238","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM","code_information":[{"code":"Px00031010275","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 100 CELLS","code_information":[{"code":"Px00031010280","type":"CDM"},{"code":"88249","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY LAB","code_information":[{"code":"Px00031010289","type":"CDM"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY LAB","code_information":[{"code":"Px00031010292","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","code_information":[{"code":"Px00031010297","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME CULTURE HARVEST","code_information":[{"code":"Px00031010298","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME KAROTYPE AMNIO FLUID","code_information":[{"code":"Px00031010302","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP CDM","code_information":[{"code":"Px00031010316","type":"CDM"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010327","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ LAB","code_information":[{"code":"Px00031010340","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FISH-ANALYZE 100-300 CELLS","code_information":[{"code":"Px00031010362","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPRETATION GTE 16 MARKERS","code_information":[{"code":"Px00031010364","type":"CDM"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 9-15 MARKERS","code_information":[{"code":"Px00031010366","type":"CDM"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010380","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM EACH ADDL SITE LAB","code_information":[{"code":"Px00031010396","type":"CDM"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISH ANALYZE 100-300 CELLS","code_information":[{"code":"Px00031010403","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":902.0,"discounted_cash":631.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":573.0,"discounted_cash":401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROSLIDE CONSULTATION W/ SLIDE PREP","code_information":[{"code":"Px00031010429","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010443","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST PNH FROFILE LAB","code_information":[{"code":"Px00031010480","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":775.0,"discounted_cash":542.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX LAB","code_information":[{"code":"Px00031010547","type":"CDM"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISSUE CULTURE AMNIOTIC FLUID","code_information":[{"code":"Px00031010549","type":"CDM"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS","code_information":[{"code":"Px00031010552","type":"CDM"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00031010568","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 50-100 CELLS","code_information":[{"code":"Px00031010575","type":"CDM"},{"code":"88248","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAINS","code_information":[{"code":"Px00031010580","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010581","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B-CELL LYMPHOMA FISH DNA PROBE EACH","code_information":[{"code":"Px00031010584","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010585","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL CDM","code_information":[{"code":"Px00031010587","type":"CDM"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC B-CELL LYMPHOMA FISH 100-300 CELLS","code_information":[{"code":"Px00031010589","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 1","code_information":[{"code":"Px00031010607","type":"CDM"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 2","code_information":[{"code":"Px00031010608","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":921.0,"discounted_cash":644.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 3","code_information":[{"code":"Px00031010609","type":"CDM"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":641.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":641.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MOLECULAR BIOLOGY PROCEDURE LAB","code_information":[{"code":"Px00031010611","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IGH PCR","code_information":[{"code":"Px00031010613","type":"CDM"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN MUT","code_information":[{"code":"Px00031010614","type":"CDM"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTO FLUID URINE OR SPUTUM TC","code_information":[{"code":"Px00031010619","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAINS GRP I TC","code_information":[{"code":"Px00031010623","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO CDM","code_information":[{"code":"Px00031010643","type":"CDM"},{"code":"81313","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031010649","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.0,"discounted_cash":1068.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TARGETED GENOMIC SEQ ANALYS","code_information":[{"code":"Px00031010659","type":"CDM"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":1071.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSITU HYBRIDIZATION (FISH) EA MULTIPLEX","code_information":[{"code":"Px00031010670","type":"CDM"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRB REARRANGEMENT ANAL AMPLIFICATION METHOD LAB","code_information":[{"code":"Px00031010677","type":"CDM"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1102.0,"discounted_cash":771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROC LEVEL 4","code_information":[{"code":"Px00031010680","type":"CDM"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIT GENE ANALYS D816 VARIANT LAB","code_information":[{"code":"Px00031010683","type":"CDM"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NRAS GENE ANALYSIS VARIANTS IN EXON 2 AND 3 LAB","code_information":[{"code":"Px00031010684","type":"CDM"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN","code_information":[{"code":"Px00031010690","type":"CDM"},{"code":"81437","type":"HCPCS"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOIMMUNE RHEUMATOID ARTHR","code_information":[{"code":"Px00031010693","type":"CDM"},{"code":"81490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":1071.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN LAB","code_information":[{"code":"Px00031010703","type":"CDM"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IGH VARIABLE REG SOM MUT","code_information":[{"code":"Px00031010705","type":"CDM"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":1022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYP2C19 GENE COM VARIANTS","code_information":[{"code":"Px00031010706","type":"CDM"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATH LEVEL 7","code_information":[{"code":"Px00031010707","type":"CDM"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6604.0,"discounted_cash":4622.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMO MICRO GENE ANA","code_information":[{"code":"Px00031010712","type":"CDM"},{"code":"81422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":760.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00031010740","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS LAB","code_information":[{"code":"Px00031010741","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CEBPA GENE ANALYSIS FULL GENE SEQUENCE","code_information":[{"code":"Px00031010749","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS","code_information":[{"code":"Px00031010772","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":760.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MOLELCULAR PATHOLOGY PROCEDURE","code_information":[{"code":"Px00031010775","type":"CDM"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1392.0,"discounted_cash":974.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","code_information":[{"code":"Px00031010799","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 3","code_information":[{"code":"Px00031010800","type":"CDM"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 CDM","code_information":[{"code":"Px00031010801","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROCEDURE LEVEL 7 LAB","code_information":[{"code":"Px00031010805","type":"CDM"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031010861","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":760.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100019","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN LAB","code_information":[{"code":"Px00031100020","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100036","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100048","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100049","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100050","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100056","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH FLUID/WASHING/BRUSHING NON GYN LAB","code_information":[{"code":"Px00031110023","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PAP-THIN PREP SCREENING","code_information":[{"code":"Px00031110033","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY LAB","code_information":[{"code":"Px00031110099","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO (RL)","code_information":[{"code":"Px00031900000","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY INFLUENZA VIRUS (RL)","code_information":[{"code":"Px00031900001","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00031900003","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLUME MEASUREMENT TIMED COLLECTION (RL)","code_information":[{"code":"Px00031900004","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS VOLUME MEASURE (RL)","code_information":[{"code":"Px00031900005","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VOLUME MEASUREMENT TIMED COLLECTION EACH CDM","code_information":[{"code":"Px00031900006","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE VOLUME MEASUREMENT TIMED EACH (RL)","code_information":[{"code":"Px00031900008","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED (RL)","code_information":[{"code":"Px00031900010","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00031900011","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN CDM","code_information":[{"code":"Px00031900012","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE (RL)","code_information":[{"code":"Px00031900013","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE CREATININE (RL)","code_information":[{"code":"Px00031900014","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE OTHER SOURCE (RL)","code_information":[{"code":"Px00031900015","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00031900018","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPT MACROBROTH (RL)","code_information":[{"code":"Px00031900020","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT CDM","code_information":[{"code":"Px00031900021","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ (RL)","code_information":[{"code":"Px00031900022","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ (RL)","code_information":[{"code":"Px00031900023","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ (RL)","code_information":[{"code":"Px00031900024","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ (RL)","code_information":[{"code":"Px00031900025","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ CDM","code_information":[{"code":"Px00031900026","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE (RL)","code_information":[{"code":"Px00031900027","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE (RL)","code_information":[{"code":"Px00031900028","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE CDM","code_information":[{"code":"Px00031900029","type":"CDM"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA (RL)","code_information":[{"code":"Px00031900030","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-1 CDM","code_information":[{"code":"Px00031900032","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HIV-2 CDM","code_information":[{"code":"Px00031900033","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE CHLAMYDIA ANY SOURCE (RL)","code_information":[{"code":"Px00031900034","type":"CDM"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM (RL)","code_information":[{"code":"Px00031900035","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00031900036","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL CDM","code_information":[{"code":"Px00031900037","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00031900038","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION (RL)","code_information":[{"code":"Px00031900039","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME (RT)","code_information":[{"code":"Px00031900040","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY (RL)","code_information":[{"code":"Px00031900043","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00031900044","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP","code_information":[{"code":"Px00031900045","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ACETYLCHOLINESTERASE CDM","code_information":[{"code":"Px00031900046","type":"CDM"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":330.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN AMNIOTIC FLUID CDM","code_information":[{"code":"Px00031900047","type":"CDM"},{"code":"82106","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":330.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00031900048","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED (RL)","code_information":[{"code":"Px00031900049","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION STREPTOMYCIN CDM","code_information":[{"code":"Px00031900050","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00031900052","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT CDM","code_information":[{"code":"Px00031900053","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRCA1 BRCA2 GENE ALYS FULL SEQ FULL DUP/DEL ALYS CDM","code_information":[{"code":"Px00031900054","type":"CDM"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":3537.0,"discounted_cash":2475.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYCORTICOSTEROIDS 17 CDM","code_information":[{"code":"Px00031900055","type":"CDM"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00031900056","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00031900057","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00031900058","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS (RL)","code_information":[{"code":"Px00031900059","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE ADAMTS 13 CDM","code_information":[{"code":"Px00031900060","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS (RL)","code_information":[{"code":"Px00031900061","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS (RL)","code_information":[{"code":"Px00031900062","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM (RL)","code_information":[{"code":"Px00031900063","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA JC VIRUS DNA AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00031900064","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED (RL)","code_information":[{"code":"Px00031900065","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED (RL)","code_information":[{"code":"Px00031900066","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IADNA HHV8 QUANTIFICATION EACH ORGANISM CDM","code_information":[{"code":"Px00031900067","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":498.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00031900068","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00031900069","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED (RL)","code_information":[{"code":"Px00031900070","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED CDM","code_information":[{"code":"Px00031900071","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTI-PHOSPHATIDYLSERINE ANTIBODY CDM","code_information":[{"code":"Px00031900072","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH CDM","code_information":[{"code":"Px00031900073","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS CDM","code_information":[{"code":"Px00031900074","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED (RL)","code_information":[{"code":"Px00031900075","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA (RL)","code_information":[{"code":"Px00031900076","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE (RL)","code_information":[{"code":"Px00031900077","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH (RL)","code_information":[{"code":"Px00031900078","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS (RL)","code_information":[{"code":"Px00031900079","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY (RL)","code_information":[{"code":"Px00031900080","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY (RL)","code_information":[{"code":"Px00031900081","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM TIME DILUTED (RL)","code_information":[{"code":"Px00031900082","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT (RL)","code_information":[{"code":"Px00031900083","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL (RL)","code_information":[{"code":"Px00031900084","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE (RL)","code_information":[{"code":"Px00031900085","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD (RL)","code_information":[{"code":"Px00031900086","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY (RL)","code_information":[{"code":"Px00031900087","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH CDM","code_information":[{"code":"Px00031900088","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA (RL)","code_information":[{"code":"Px00031900090","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY CDM","code_information":[{"code":"Px00031900091","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY CDM","code_information":[{"code":"Px00031900092","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL CDM","code_information":[{"code":"Px00031900095","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH CDM","code_information":[{"code":"Px00031900096","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00031900097","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA T AMPLIF NA PROBE (RL)","code_information":[{"code":"Px00031900099","type":"CDM"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT OR AFB STAIN (RL)","code_information":[{"code":"Px00031900100","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE AFB - ISOL & ID (RL)","code_information":[{"code":"Px00031900101","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES CDM","code_information":[{"code":"Px00031900102","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROCEDURE LEVEL 2 (RL)","code_information":[{"code":"Px00031900103","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 CDM","code_information":[{"code":"Px00031900104","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS CDM","code_information":[{"code":"Px00031900105","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900106","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AB RICKETTSIA (RL)","code_information":[{"code":"Px00031900107","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP CDM","code_information":[{"code":"Px00031900108","type":"CDM"},{"code":"83951","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SALMONELLA CDM","code_information":[{"code":"Px00031900109","type":"CDM"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00031900110","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ZIKA VIRUS IGM ANTIBODY CDM","code_information":[{"code":"Px00031900111","type":"CDM"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00031900112","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00031900113","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3 (RL)","code_information":[{"code":"Px00031900114","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE CDM","code_information":[{"code":"Px00031900115","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 CDM","code_information":[{"code":"Px00031900116","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00031900117","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UGT1A1 GENE ANALYSIS COMMON VARIANTS CDM","code_information":[{"code":"Px00031900118","type":"CDM"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00031900122","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00031900123","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00031900124","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOTAL ESTRADIOL CDM","code_information":[{"code":"Px00031900125","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00031900126","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN CDM","code_information":[{"code":"Px00031900127","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTROGENS TOTAL CDM","code_information":[{"code":"Px00031900128","type":"CDM"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE CDM","code_information":[{"code":"Px00031900129","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY BIOVLBL TESTOSTERONE DIRECT MEASUREMENT CDM","code_information":[{"code":"Px00031900130","type":"CDM"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900132","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00031900133","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUAN EA (RL)","code_information":[{"code":"Px00031900136","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY IGA/IGD/IGG/IGM EACH (RL)","code_information":[{"code":"Px00031900137","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN (RL)","code_information":[{"code":"Px00031900138","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL BANDS (RL)","code_information":[{"code":"Px00031900139","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00031900140","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CADMIUM CDM","code_information":[{"code":"Px00031900141","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00031900142","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD CDM","code_information":[{"code":"Px00031900143","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MERCURY QUANTITATIVE CDM","code_information":[{"code":"Px00031900144","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE NOT BLOOD (RL)","code_information":[{"code":"Px00031900145","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SERUM IMMUNOFIXATION ELECTROPHORES (RL)","code_information":[{"code":"Px00031900146","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY IGA/IGD/IGG/IGM EACH (RL)","code_information":[{"code":"Px00031900147","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3 (RL)","code_information":[{"code":"Px00031900148","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM","code_information":[{"code":"Px00031900149","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00031900150","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO CDM","code_information":[{"code":"Px00031900151","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) CDM","code_information":[{"code":"Px00031900152","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL CDM","code_information":[{"code":"Px00031900153","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE CDM","code_information":[{"code":"Px00031900154","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE CDM","code_information":[{"code":"Px00031900155","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC CDM","code_information":[{"code":"Px00031900156","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00031900157","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM","code_information":[{"code":"Px00031900158","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00031900159","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900160","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900161","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE (RL)","code_information":[{"code":"Px00031900162","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE CDM","code_information":[{"code":"Px00031900163","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00031900164","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL CDM","code_information":[{"code":"Px00031900165","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEOXYCORTISOL 11- CDM","code_information":[{"code":"Px00031900166","type":"CDM"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL CDM","code_information":[{"code":"Px00031900167","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC 17-HYDROXYPREGNENOLONE CDM","code_information":[{"code":"Px00031900168","type":"CDM"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESOXYCORTICOSTERONE 11- CDM","code_information":[{"code":"Px00031900169","type":"CDM"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D CDM","code_information":[{"code":"Px00031900170","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00031900171","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE (RL)","code_information":[{"code":"Px00031900172","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DHEA (RL)","code_information":[{"code":"Px00031900173","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL (RL)","code_information":[{"code":"Px00031900174","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HYDROXYPROGESTERONE 17-D (RL)","code_information":[{"code":"Px00031900175","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT CDM","code_information":[{"code":"Px00031900176","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00031900177","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 CDM","code_information":[{"code":"Px00031900178","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00031900179","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI(RL)","code_information":[{"code":"Px00031900180","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORPHOBILINOGEN URINE QUAN (RL)","code_information":[{"code":"Px00031900181","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE CDM","code_information":[{"code":"Px00031900182","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT AB QUAN PROTEIN CSF LAB","code_information":[{"code":"Px00031900183","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WB IM ID FOR BANDS","code_information":[{"code":"Px00031900184","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM","code_information":[{"code":"Px00031900185","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00031900186","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00031900187","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOPATH PROCEDURE LEVEL 2 (RL)","code_information":[{"code":"Px00031900188","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900189","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLG SPEC IGE CRUDE XTRC EA (RL)","code_information":[{"code":"Px00031900190","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOM URINALYSIS WO MICRO (RL)","code_information":[{"code":"Px00031900191","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS SGL QUAN EA (RL)","code_information":[{"code":"Px00031900192","type":"CDM"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMMONIA (RL)","code_information":[{"code":"Px00031900193","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUAN TIMED (RL)","code_information":[{"code":"Px00031900194","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE (RL)","code_information":[{"code":"Px00031900195","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CITRATE (RL)","code_information":[{"code":"Px00031900196","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE NOT BLOOD (RL)","code_information":[{"code":"Px00031900197","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM (RL)","code_information":[{"code":"Px00031900198","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE (RL)","code_information":[{"code":"Px00031900199","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OXALATE (RL)","code_information":[{"code":"Px00031900200","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINE SULFATE (RL)","code_information":[{"code":"Px00031900204","type":"CDM"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900206","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900207","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AB YERSINIA (RL)","code_information":[{"code":"Px00031900208","type":"CDM"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HHV-7","code_information":[{"code":"Px00031900209","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900210","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900211","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELMINTH FILARIASIS CDM","code_information":[{"code":"Px00031900212","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CONFIRMATORY TEST CDM","code_information":[{"code":"Px00031900213","type":"CDM"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00031900214","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL CDM","code_information":[{"code":"Px00031900215","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DNA/RNA DIRECT PROBE (RL)","code_information":[{"code":"Px00031900216","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00031900217","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00031900218","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE CDM","code_information":[{"code":"Px00031900219","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00031900220","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AB RICKETTSIA (RL)","code_information":[{"code":"Px00031900221","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3 (RL)","code_information":[{"code":"Px00031900222","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00031900223","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM","code_information":[{"code":"Px00031900224","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL IMMUNE CDM","code_information":[{"code":"Px00031900225","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00031900226","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 CDM","code_information":[{"code":"Px00031900227","type":"CDM"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00031900228","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS CDM","code_information":[{"code":"Px00031900229","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS CDM","code_information":[{"code":"Px00031900230","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA CDM","code_information":[{"code":"Px00031900231","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA CDM","code_information":[{"code":"Px00031900232","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA CDM","code_information":[{"code":"Px00031900233","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL CDM","code_information":[{"code":"Px00031900234","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE CDM","code_information":[{"code":"Px00031900235","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 (RL)","code_information":[{"code":"Px00031900236","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ARSENIC CDM","code_information":[{"code":"Px00031900237","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00031900238","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EHRLICHIA CDM","code_information":[{"code":"Px00031900239","type":"CDM"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CONFIRMATORY TEST CDM","code_information":[{"code":"Px00031900240","type":"CDM"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM CDM","code_information":[{"code":"Px00031900241","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM CDM","code_information":[{"code":"Px00031900242","type":"CDM"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLD QUAN PART (RL)","code_information":[{"code":"Px00031900243","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS CDM","code_information":[{"code":"Px00031900244","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC CDM","code_information":[{"code":"Px00031900245","type":"CDM"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEROTONIN CDM","code_information":[{"code":"Px00031900246","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELMINTH SCHISTOSOMA CDM","code_information":[{"code":"Px00031900247","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AB FUNGUS NES (RL)","code_information":[{"code":"Px00031900248","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT AB TITER EA AB (RL)","code_information":[{"code":"Px00031900249","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HYDROXYPROGESTERONE 17-D (RL)","code_information":[{"code":"Px00031900250","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VIRUS ISOL SHELL VIAL TECHN (RL)","code_information":[{"code":"Px00031900253","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES CDM","code_information":[{"code":"Px00031900254","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00031900255","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS CDM","code_information":[{"code":"Px00031900256","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY CDM","code_information":[{"code":"Px00031900257","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA","code_information":[{"code":"Px00031900258","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SENSITIVITY - MYCOBACT EA AGNT (RL)","code_information":[{"code":"Px00031900259","type":"CDM"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD","code_information":[{"code":"Px00031900260","type":"CDM"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZ TISS FOR CULTURE (RL)","code_information":[{"code":"Px00031900261","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION FOR INFECT AGNT (RL)","code_information":[{"code":"Px00031900262","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZ TISS FOR CULTURE (RL)","code_information":[{"code":"Px00031900263","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION FOR INFECT AGNT (RL)","code_information":[{"code":"Px00031900264","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ZIKA VIRUS DNA/RNA AMP PROBE (RL)","code_information":[{"code":"Px00031900265","type":"CDM"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES CDM","code_information":[{"code":"Px00031900266","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 CDM","code_information":[{"code":"Px00031900267","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE CDM","code_information":[{"code":"Px00031900268","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BENZODIAZEPINES 13 OR MORE (RL)","code_information":[{"code":"Px00031900269","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL (RL)","code_information":[{"code":"Px00031900270","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE CDM","code_information":[{"code":"Px00031900271","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00031900272","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES (RL)","code_information":[{"code":"Px00031900273","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALCOHOLS BIOMARKERS 1OR 2 (RL)","code_information":[{"code":"Px00031900274","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL (RL)","code_information":[{"code":"Px00031900275","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PCP QUAN ASSAY (RL)","code_information":[{"code":"Px00031900276","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTALCOHOLS (RL)","code_information":[{"code":"Px00031900278","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE (RL)","code_information":[{"code":"Px00031900279","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE CDM","code_information":[{"code":"Px00031900281","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE (RL)","code_information":[{"code":"Px00031900283","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEROIN METABOLITE (RL)","code_information":[{"code":"Px00031900287","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE (RL)","code_information":[{"code":"Px00031900288","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM","code_information":[{"code":"Px00031900291","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00031900292","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GENTAMICIN CDM","code_information":[{"code":"Px00031900293","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GENTAMICIN CDM","code_information":[{"code":"Px00031900294","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT CDM","code_information":[{"code":"Px00032000001","type":"CDM"},{"code":"76145","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SFTY IMPLT&/FB ASMT STF INITIAL 15 MIN CDM","code_information":[{"code":"Px00032000013","type":"CDM"},{"code":"76014","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SFTY MPLT&/FB ASMT STF EA ADDL 30 MIN CDM","code_information":[{"code":"Px00032000014","type":"CDM"},{"code":"76015","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SAFETY DETERMINATION PHYS/QHP CDM","code_information":[{"code":"Px00032000015","type":"CDM"},{"code":"76016","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":261.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SFTY MED PHYSICS XM CSTMZ CDM","code_information":[{"code":"Px00032000016","type":"CDM"},{"code":"76017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.0,"discounted_cash":718.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SAFETY IMPLANT ELEC PREPJ CDM","code_information":[{"code":"Px00032000017","type":"CDM"},{"code":"76018","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR SAFETY IMPLT POS&/IMMOBLJ CDM","code_information":[{"code":"Px00032000018","type":"CDM"},{"code":"76019","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CISTERNOGRAM","code_information":[{"code":"Px00032010002","type":"CDM"},{"code":"70015","type":"HCPCS"}],"standard_charges":[{"gross_charge":4062.0,"discounted_cash":2843.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":422.0,"discounted_cash":295.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":502.0,"discounted_cash":351.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MASTOIDS UNI LT/3 VIEWS","code_information":[{"code":"Px00032010008","type":"CDM"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":502.0,"discounted_cash":351.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MASTOIDS 3/PLUS VIEWS","code_information":[{"code":"Px00032010009","type":"CDM"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":632.0,"discounted_cash":442.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR OPTIC FORAMINA","code_information":[{"code":"Px00032010016","type":"CDM"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":632.0,"discounted_cash":442.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SINUSES PARANASAL LT/3 VIEWS","code_information":[{"code":"Px00032010018","type":"CDM"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":502.0,"discounted_cash":351.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":632.0,"discounted_cash":442.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SELLA TURCICA","code_information":[{"code":"Px00032010021","type":"CDM"},{"code":"70240","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":502.0,"discounted_cash":351.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":716.0,"discounted_cash":501.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":688.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":628.0,"discounted_cash":439.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":736.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":669.0,"discounted_cash":468.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":356.0,"discounted_cash":249.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":289.0,"discounted_cash":202.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SALIVARY GLAND FOR CALCULUS","code_information":[{"code":"Px00032010035","type":"CDM"},{"code":"70380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":820.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR SALIVARY DUCT SIALOGRAPHY","code_information":[{"code":"Px00032010036","type":"CDM"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":879.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":693.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":632.0,"discounted_cash":442.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":871.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":795.0,"discounted_cash":556.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":887.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":798.0,"discounted_cash":558.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":321.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":712.0,"discounted_cash":498.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":716.0,"discounted_cash":501.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":774.0,"discounted_cash":541.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":571.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":521.0,"discounted_cash":364.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":558.0,"discounted_cash":390.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":527.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":480.0,"discounted_cash":336.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":716.0,"discounted_cash":501.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1415.0,"discounted_cash":990.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":901.0,"discounted_cash":630.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":473.0,"discounted_cash":331.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":648.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":589.0,"discounted_cash":412.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":660.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":589.0,"discounted_cash":412.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":536.0,"discounted_cash":375.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":732.0,"discounted_cash":512.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS","code_information":[{"code":"Px00032010067","type":"CDM"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1415.0,"discounted_cash":990.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":901.0,"discounted_cash":630.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SPINE 2-3 VIEWS LUMBAR BEND ONLY","code_information":[{"code":"Px00032010068","type":"CDM"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR PELVIS MIN 3 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010072","type":"CDM"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":575.0,"discounted_cash":402.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":502.0,"discounted_cash":351.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":321.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MYELOGRAPHY CERVICAL","code_information":[{"code":"Px00032010076","type":"CDM"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":4372.0,"discounted_cash":3060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY THORACIC","code_information":[{"code":"Px00032010077","type":"CDM"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":3990.0,"discounted_cash":2793.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY LUMBAR","code_information":[{"code":"Px00032010078","type":"CDM"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3758.0,"discounted_cash":2630.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR MYELOGRAPHY SPINE 2/PLUS REGIONS","code_information":[{"code":"Px00032010079","type":"CDM"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5614.0,"discounted_cash":3929.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY CERVICAL/THORACIC","code_information":[{"code":"Px00032010081","type":"CDM"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3545.0,"discounted_cash":2481.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR DISKOGRAPHY LUMBAR","code_information":[{"code":"Px00032010083","type":"CDM"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":1850.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":382.0,"discounted_cash":267.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":427.0,"discounted_cash":298.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":382.0,"discounted_cash":267.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SHOULDER ARTHROGRAPHY","code_information":[{"code":"Px00032010097","type":"CDM"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1357.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST ANKLE","code_information":[{"code":"Px00032010098","type":"CDM"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.0,"discounted_cash":1325.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":536.0,"discounted_cash":375.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR JAW PANARAMIC","code_information":[{"code":"Px00032010100","type":"CDM"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":321.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":459.0,"discounted_cash":321.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":389.0,"discounted_cash":272.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ARTHROGRAM OF ELBOW","code_information":[{"code":"Px00032010111","type":"CDM"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1357.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":427.0,"discounted_cash":298.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00032010122","type":"CDM"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":1135.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":427.0,"discounted_cash":298.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":373.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":427.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR HIP ARTHROGRAPHY","code_information":[{"code":"Px00032010140","type":"CDM"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1357.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":458.0,"discounted_cash":320.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":532.0,"discounted_cash":372.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":741.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":676.0,"discounted_cash":473.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR KNEE JOINT W CONTRAST","code_information":[{"code":"Px00032010157","type":"CDM"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2373.0,"discounted_cash":1661.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1901.0,"discounted_cash":1330.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":489.0,"discounted_cash":342.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":499.0,"discounted_cash":349.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR PERITONEUM","code_information":[{"code":"Px00032010176","type":"CDM"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.0,"discounted_cash":1444.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST THROAT","code_information":[{"code":"Px00032010177","type":"CDM"},{"code":"74210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":876.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1374.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":876.0,"discounted_cash":613.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2312.0,"discounted_cash":1618.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1474.0,"discounted_cash":1031.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2556.0,"discounted_cash":1789.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1132.0,"discounted_cash":792.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":858.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":876.0,"discounted_cash":613.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":1374.0,"discounted_cash":961.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR COLON W CONTRAST","code_information":[{"code":"Px00032010191","type":"CDM"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1147.0,"discounted_cash":802.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR COLON DOUBLE CONTRAST","code_information":[{"code":"Px00032010192","type":"CDM"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":1652.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1504.0,"discounted_cash":1052.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR COLON ENEMA AIR/CONTRAST BLOCKAGE","code_information":[{"code":"Px00032010193","type":"CDM"},{"code":"74283","type":"HCPCS"}],"standard_charges":[{"gross_charge":2368.0,"discounted_cash":1657.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CONTRAST GALLBLADDER","code_information":[{"code":"Px00032010194","type":"CDM"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1091.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":995.0,"discounted_cash":696.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR BILE DUCT ENDOSCOPY","code_information":[{"code":"Px00032010201","type":"CDM"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR FOR PANCREAS ENDOSCOPY CATH","code_information":[{"code":"Px00032010202","type":"CDM"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR BILE/PANC ENDOSCOPY","code_information":[{"code":"Px00032010203","type":"CDM"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":2317.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR INTRO LONG GI TUBE","code_information":[{"code":"Px00032010204","type":"CDM"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1044.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR UROGRAPHY W/WO TOMOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010208","type":"CDM"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1246.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UROGRAPHY INFUSION","code_information":[{"code":"Px00032010209","type":"CDM"},{"code":"74410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2491.0,"discounted_cash":1743.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UROGRAPHY INFUSION W/TOMOGRAPHY","code_information":[{"code":"Px00032010210","type":"CDM"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":4840.0,"discounted_cash":3388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2773.0,"discounted_cash":1941.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1769.0,"discounted_cash":1238.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR UROGRAPHY ANTEGRADE W CONTRAST","code_information":[{"code":"Px00032010212","type":"CDM"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":983.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":898.0,"discounted_cash":628.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CYSTOGRAPHY MIN 3 VIEWS W CONTRAST","code_information":[{"code":"Px00032010213","type":"CDM"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":858.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":783.0,"discounted_cash":548.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR URETHRA/BLADDER RETRO W CONTRAST","code_information":[{"code":"Px00032010216","type":"CDM"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":858.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":783.0,"discounted_cash":548.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR URETHRA/BLADDER VOIDING","code_information":[{"code":"Px00032010217","type":"CDM"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1662.0,"discounted_cash":1163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1061.0,"discounted_cash":742.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR KIDNEY LESION","code_information":[{"code":"Px00032010218","type":"CDM"},{"code":"74470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1113.0,"discounted_cash":779.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DILATION URETERS/URETHRA RS&I","code_information":[{"code":"Px00032010221","type":"CDM"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":8197.0,"discounted_cash":5737.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1503.0,"discounted_cash":1052.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR PERINEUM","code_information":[{"code":"Px00032010225","type":"CDM"},{"code":"74775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR AORTOGRAPHY THORACIC SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010227","type":"CDM"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR AORTOGRAPHY ABDOMEN SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010228","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9824.0,"discounted_cash":6876.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR AORTOGRAPHY ABD BI ILIOFEM SERIALOGRAPHY W CONTRAST","code_information":[{"code":"Px00032010229","type":"CDM"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":12305.0,"discounted_cash":8613.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9844.0,"discounted_cash":6890.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANGIO SPINE SELECTIVE W CONTRAST","code_information":[{"code":"Px00032010239","type":"CDM"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":3905.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EXTREMITY UNILATERAL W CONTRAST","code_information":[{"code":"Px00032010240","type":"CDM"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9824.0,"discounted_cash":6876.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANGIOGRAPHY EXTREMITY BILATERAL RS&I","code_information":[{"code":"Px00032010241","type":"CDM"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9824.0,"discounted_cash":6876.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANGIO ABDOMEN VISCERAL W CONTRAST","code_information":[{"code":"Px00032010244","type":"CDM"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":13598.0,"discounted_cash":9518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":10878.0,"discounted_cash":7614.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I","code_information":[{"code":"Px00032010245","type":"CDM"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ARTERY ADRENALS BILAT","code_information":[{"code":"Px00032010246","type":"CDM"},{"code":"75733","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO PELVIC W CONTRAST","code_information":[{"code":"Px00032010247","type":"CDM"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9824.0,"discounted_cash":6876.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ANGIO PULMONARY W CONTRAST UNI","code_information":[{"code":"Px00032010248","type":"CDM"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ARTERY LUNG NON-SELECTIVE","code_information":[{"code":"Px00032010250","type":"CDM"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":11815.0,"discounted_cash":8270.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EA ADDITIONAL VESSEL","code_information":[{"code":"Px00032010252","type":"CDM"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":4275.0,"discounted_cash":2992.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3422.0,"discounted_cash":2395.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR VEINS EXTREMITY UNI W CONTRAST","code_information":[{"code":"Px00032010260","type":"CDM"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":4404.0,"discounted_cash":3082.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3525.0,"discounted_cash":2467.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR VEINS EXTREMITY BIL W CONTRAST","code_information":[{"code":"Px00032010261","type":"CDM"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":4404.0,"discounted_cash":3082.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR VEINS CAVAL INFERIOR W CONTRAST","code_information":[{"code":"Px00032010262","type":"CDM"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR VEINS CAVAL SUPERIOR W CONTRAST","code_information":[{"code":"Px00032010263","type":"CDM"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":11590.0,"discounted_cash":8113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR VEIN KIDNEY UNI W CONTRAST","code_information":[{"code":"Px00032010264","type":"CDM"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":13598.0,"discounted_cash":9518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR VEINS VENOUS SINUS W CONTRAST","code_information":[{"code":"Px00032010268","type":"CDM"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":4541.0,"discounted_cash":3178.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3633.0,"discounted_cash":2543.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ADDITIONAL FILMS/VIEWS","code_information":[{"code":"Px00032010276","type":"CDM"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR VENOUS SAMPLING W/WO ANGIO","code_information":[{"code":"Px00032010284","type":"CDM"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ANGIO EXISTING CATH NO THROMBO","code_information":[{"code":"Px00032010287","type":"CDM"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":7388.0,"discounted_cash":5171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE CVA DEVICE OBSTRUCT","code_information":[{"code":"Px00032010289","type":"CDM"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":2277.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE CVA LUMEN OBSTRUCT","code_information":[{"code":"Px00032010290","type":"CDM"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":2277.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VASCULAR BIOPSY TRANSCATHETER","code_information":[{"code":"Px00032010307","type":"CDM"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":6842.0,"discounted_cash":4789.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":4362.0,"discounted_cash":3053.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CHANGE TUBE/CATH W CONTRAST","code_information":[{"code":"Px00032010311","type":"CDM"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":3129.0,"discounted_cash":2190.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3343.0,"discounted_cash":2340.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":843.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":964.0,"discounted_cash":674.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":843.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":769.0,"discounted_cash":538.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FISTULA/SINUS ABSCESS","code_information":[{"code":"Px00032010321","type":"CDM"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1227.0,"discounted_cash":858.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"Px00032010322","type":"CDM"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":1989.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1811.0,"discounted_cash":1267.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC TOMOGRAPHY SINGLE PLANE","code_information":[{"code":"Px00032010323","type":"CDM"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.0,"discounted_cash":927.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1739.0,"discounted_cash":1217.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1390.0,"discounted_cash":973.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC FL GUIDE PLCMT NEEDLE ADD ON","code_information":[{"code":"Px00032010331","type":"CDM"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1932.0,"discounted_cash":1352.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1543.0,"discounted_cash":1080.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC FLUOROGUIDE FOR SPINE INJECT","code_information":[{"code":"Px00032010332","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1937.0,"discounted_cash":1355.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1554.0,"discounted_cash":1087.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MAMMARY DUCT SINGLE","code_information":[{"code":"Px00032010335","type":"CDM"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1126.0,"discounted_cash":788.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR MAMMARY DUCT MULTIPLE","code_information":[{"code":"Px00032010336","type":"CDM"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":2028.0,"discounted_cash":1419.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","code_information":[{"code":"Px00032010337","type":"CDM"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":417.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":421.0,"discounted_cash":294.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.0,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":1206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1099.0,"discounted_cash":769.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":1029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":936.0,"discounted_cash":655.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR DXA BONE DENSITY STUDY AXIAL","code_information":[{"code":"Px00032010344","type":"CDM"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":581.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":530.0,"discounted_cash":371.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC BONE DENSITY PERIPHERAL SKELETON","code_information":[{"code":"Px00032010345","type":"CDM"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIOLOGY UNLISTED PROCEDURE","code_information":[{"code":"Px00032010465","type":"CDM"},{"code":"76499","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":813.0,"discounted_cash":569.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":518.0,"discounted_cash":362.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":397.0,"discounted_cash":277.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC AORTOGRAPHY ABDOMINAL INTRAOPERATIVE","code_information":[{"code":"Px00032010523","type":"CDM"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":12282.0,"discounted_cash":8597.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":9824.0,"discounted_cash":6876.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC PAIN MANAGEMENT PROC W/FLUORO","code_information":[{"code":"Px00032010578","type":"CDM"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1937.0,"discounted_cash":1355.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":571.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":505.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":405.0,"discounted_cash":283.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC VERTEB FRACTURE ASSESSMENT VIA DXA","code_information":[{"code":"Px00032010603","type":"CDM"},{"code":"77086","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":262.0,"discounted_cash":183.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE 2 OR 3 VIEWS","code_information":[{"code":"Px00032010605","type":"CDM"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":433.0,"discounted_cash":303.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE 4 OR 5 VIEWS","code_information":[{"code":"Px00032010606","type":"CDM"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":827.0,"discounted_cash":578.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR ENTIRE SPINE MIN 6 VIEWS","code_information":[{"code":"Px00032010607","type":"CDM"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":827.0,"discounted_cash":578.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":216.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":262.0,"discounted_cash":183.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":433.0,"discounted_cash":303.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":433.0,"discounted_cash":303.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":262.0,"discounted_cash":183.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR TMJ ARTHROGRAM","code_information":[{"code":"Px00032210001","type":"CDM"},{"code":"70332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":447.0,"discounted_cash":312.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":527.0,"discounted_cash":368.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":578.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CHEMO SQ OR IM NON HORMONAL CDM","code_information":[{"code":"Px00033110001","type":"CDM"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMO INJECTION VIA SUBQ RESERVOIR CDM","code_information":[{"code":"Px00033110006","type":"CDM"},{"code":"96542","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OFFICE CONSULTATION LEVEL 5","code_information":[{"code":"Px00033310001","type":"CDM"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION SIMPLE","code_information":[{"code":"Px00033310006","type":"CDM"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"discounted_cash":913.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION INTERMEDIATE","code_information":[{"code":"Px00033310007","type":"CDM"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2128.0,"discounted_cash":1489.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION COMPLEX","code_information":[{"code":"Px00033310008","type":"CDM"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2793.0,"discounted_cash":1955.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THER RAD SIMULATION 3D","code_information":[{"code":"Px00033310009","type":"CDM"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":10437.0,"discounted_cash":7305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BASIC DOSIMETRY CALC","code_information":[{"code":"Px00033310010","type":"CDM"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIOTHERAPY DOSE PLAN, IMRT","code_information":[{"code":"Px00033310012","type":"CDM"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":10437.0,"discounted_cash":7305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL TELETX PORT PLAN","code_information":[{"code":"Px00033310018","type":"CDM"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1568.0,"discounted_cash":1097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION DOSIMETRY","code_information":[{"code":"Px00033310022","type":"CDM"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES SIMPLE","code_information":[{"code":"Px00033310023","type":"CDM"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES INTERMEDIATE","code_information":[{"code":"Px00033310024","type":"CDM"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TREATMENT DEVICES COMPLEX","code_information":[{"code":"Px00033310025","type":"CDM"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":855.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONTINUING PHYSICS CONSULT","code_information":[{"code":"Px00033310027","type":"CDM"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":784.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"Px00033310028","type":"CDM"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":10437.0,"discounted_cash":7305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL PHYSICS CONSULT","code_information":[{"code":"Px00033310029","type":"CDM"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT","code_information":[{"code":"Px00033310030","type":"CDM"},{"code":"77371","type":"HCPCS"}],"standard_charges":[{"gross_charge":17597.0,"discounted_cash":12317.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SRS CRANIAL LINEAR ACCEL 1 SESSION","code_information":[{"code":"Px00033310034","type":"CDM"},{"code":"77372","type":"HCPCS"}],"standard_charges":[{"gross_charge":17597.0,"discounted_cash":12317.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SBRT DELIVERY","code_information":[{"code":"Px00033310035","type":"CDM"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":9415.0,"discounted_cash":6590.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORT VERIF FILMS PER 5 FRACTNS","code_information":[{"code":"Px00033310051","type":"CDM"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"Px00033310057","type":"CDM"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2727.0,"discounted_cash":1908.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INFUSE/INTILL RADIOELEMENT","code_information":[{"code":"Px00033310058","type":"CDM"},{"code":"77750","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":640.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT SIMPLE","code_information":[{"code":"Px00033310059","type":"CDM"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1246.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT INTERM","code_information":[{"code":"Px00033310060","type":"CDM"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3394.0,"discounted_cash":2375.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLY INTRCAV RADIAT COMPL","code_information":[{"code":"Px00033310061","type":"CDM"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":3771.0,"discounted_cash":2639.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLY INTERSTITIAL RAD SRC COMPLX","code_information":[{"code":"Px00033310064","type":"CDM"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":5257.0,"discounted_cash":3679.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIATION HANDLING","code_information":[{"code":"Px00033310074","type":"CDM"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT VAGINAL BRACHYTX DEVICE","code_information":[{"code":"Px00033310083","type":"CDM"},{"code":"57156","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT INTERSTITIAL MARKERS ABDOMINAL/PELVIC FOR RAD THERAPY","code_information":[{"code":"Px00033310085","type":"CDM"},{"code":"49411","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":783.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE RT DEVICE/MARKER PROS","code_information":[{"code":"Px00033310087","type":"CDM"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3719.0,"discounted_cash":2603.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RESPIRATOR MOTION MGMT SIMUL","code_information":[{"code":"Px00033310090","type":"CDM"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":1302.0,"discounted_cash":911.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310091","type":"CDM"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TELETHX ISODOSE PLAN COMPLEX","code_information":[{"code":"Px00033310092","type":"CDM"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE PLAN SIMPLE","code_information":[{"code":"Px00033310093","type":"CDM"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE INTERMEDIATE","code_information":[{"code":"Px00033310094","type":"CDM"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":1099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHYTX ISODOSE COMPLEX","code_information":[{"code":"Px00033310095","type":"CDM"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":1099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY SIMPLE","code_information":[{"code":"Px00033310096","type":"CDM"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.0,"discounted_cash":1775.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMRT DELIVERY COMPLEX","code_information":[{"code":"Px00033310097","type":"CDM"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.0,"discounted_cash":1775.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":612.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RAD TX SIMPLE","code_information":[{"code":"Px00033310099","type":"CDM"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RAD TX COMPLEX","code_information":[{"code":"Px00033310101","type":"CDM"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.0,"discounted_cash":897.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TPRNL PLMT BIODEGRADABLE MATRL 1MLT/NJX","code_information":[{"code":"Px00033310164","type":"CDM"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6095.0,"discounted_cash":4266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRACHTX 1 CHANNEL","code_information":[{"code":"Px00033320002","type":"CDM"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":2292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX 2-12 CHANNELS","code_information":[{"code":"Px00033320003","type":"CDM"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":2292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HDR RDNCL NTRSTL/INTRCAV BRCHTX OVER 12 CHANNELS","code_information":[{"code":"Px00033320004","type":"CDM"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":2292.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV PUSH ADDL DRUG CDM","code_information":[{"code":"Px00033510002","type":"CDM"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":925.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1384.0,"discounted_cash":968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMO ADMIN PLEURAL CAVITY INCL THORACENTESIS CDM","code_information":[{"code":"Px00033510012","type":"CDM"},{"code":"96440","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMO ADMIN PERITONEAL CAVITY VIA PORT OR CATH CDM","code_information":[{"code":"Px00033510013","type":"CDM"},{"code":"96446","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1183.0,"discounted_cash":828.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUMOR IMAGING LIMITED AREA F/U","code_information":[{"code":"Px00034010007","type":"CDM"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":1411.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG CDM","code_information":[{"code":"Px00034010008","type":"CDM"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":5449.0,"discounted_cash":3814.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION DIFF","code_information":[{"code":"Px00034010009","type":"CDM"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":875.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM","code_information":[{"code":"Px00034010010","type":"CDM"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":751.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROID MET IMAGING WHOLE BODY","code_information":[{"code":"Px00034110007","type":"CDM"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1554.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PARATHYROID","code_information":[{"code":"Px00034110009","type":"CDM"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":664.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADRENAL IMAGING","code_information":[{"code":"Px00034110010","type":"CDM"},{"code":"78075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":2116.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED PROCEDURE ENDOCRINE","code_information":[{"code":"Px00034110011","type":"CDM"},{"code":"78099","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":991.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPLEEN IMAGING","code_information":[{"code":"Px00034110020","type":"CDM"},{"code":"78185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM LYMPH SYSTEM","code_information":[{"code":"Px00034110021","type":"CDM"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":4073.0,"discounted_cash":2851.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIVER IMAGING STATIC","code_information":[{"code":"Px00034110023","type":"CDM"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIVER IMAGING W/VASCULAR FLOW","code_information":[{"code":"Px00034110024","type":"CDM"},{"code":"78202","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.0,"discounted_cash":956.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM LIVER SPLEEN STATIC ONLY","code_information":[{"code":"Px00034110027","type":"CDM"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LIVER & SPLEEN IMAGE W/ VASCULAR FLOW","code_information":[{"code":"Px00034110028","type":"CDM"},{"code":"78216","type":"HCPCS"}],"standard_charges":[{"gross_charge":2117.0,"discounted_cash":1481.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGEAL MOTILITY STUDY","code_information":[{"code":"Px00034110034","type":"CDM"},{"code":"78258","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM GASTROESOPHAGEAL REFLUX STUDY","code_information":[{"code":"Px00034110036","type":"CDM"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING IMG STDY","code_information":[{"code":"Px00034110037","type":"CDM"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1091.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BREATH TST ATTAIN/ANALYSIS C-14","code_information":[{"code":"Px00034110038","type":"CDM"},{"code":"78267","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC KIDNEY IMAGING MORPHOLOGY","code_information":[{"code":"Px00034110041","type":"CDM"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":1009.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM ACUTE GI BLEED STUDY","code_information":[{"code":"Px00034110042","type":"CDM"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":1408.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM INTESTINE MECKEL VOLVULUS","code_information":[{"code":"Px00034110044","type":"CDM"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1319.0,"discounted_cash":923.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PERITONEAL VENOUS SHUNT PATENCY","code_information":[{"code":"Px00034110045","type":"CDM"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.0,"discounted_cash":1278.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110046","type":"CDM"},{"code":"78299","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":631.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1165.0,"discounted_cash":815.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1975.0,"discounted_cash":1382.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2423.0,"discounted_cash":1696.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MUSCULOSKELETAL EXAM UNLISTED","code_information":[{"code":"Px00034110052","type":"CDM"},{"code":"78399","type":"HCPCS"}],"standard_charges":[{"gross_charge":6297.0,"discounted_cash":4407.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT SINGLE","code_information":[{"code":"Px00034110055","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3646.0,"discounted_cash":2552.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM MYCARD PERFUS SPECT MULTIPLE","code_information":[{"code":"Px00034110056","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5072.0,"discounted_cash":3550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VENOUS THROMBOSIS IMAGING","code_information":[{"code":"Px00034110059","type":"CDM"},{"code":"78457","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VENOUS THROMBOSIS IMAGE BILAT","code_information":[{"code":"Px00034110060","type":"CDM"},{"code":"78458","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":1243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEART INFARCT IMAGE","code_information":[{"code":"Px00034110061","type":"CDM"},{"code":"78466","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEART INFARCT IMAGE (3D)","code_information":[{"code":"Px00034110063","type":"CDM"},{"code":"78469","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM CARDIAC BLOOD POOL SINGLE","code_information":[{"code":"Px00034110064","type":"CDM"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2254.0,"discounted_cash":1577.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM CARDIAC BLOOD POOL MULTIPLE","code_information":[{"code":"Px00034110065","type":"CDM"},{"code":"78473","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.0,"discounted_cash":2298.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEART IMAGE BLOOD POOL GATED SPECT","code_information":[{"code":"Px00034110068","type":"CDM"},{"code":"78494","type":"HCPCS"}],"standard_charges":[{"gross_charge":3894.0,"discounted_cash":2725.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOVASCULAR EXAM UNLISTED","code_information":[{"code":"Px00034110069","type":"CDM"},{"code":"78499","type":"HCPCS"}],"standard_charges":[{"gross_charge":3116.0,"discounted_cash":2181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION PARTICULATE","code_information":[{"code":"Px00034110070","type":"CDM"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":1028.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PULMONARY VENTILATION IMAGING","code_information":[{"code":"Px00034110072","type":"CDM"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT IMAGING","code_information":[{"code":"Px00034110073","type":"CDM"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":1029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM PULM PERFUSION VENT DIFF","code_information":[{"code":"Px00034110077","type":"CDM"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":1029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110078","type":"CDM"},{"code":"78599","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":725.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRAIN IMAGE LT/4 VIEWS STATIC","code_information":[{"code":"Px00034110079","type":"CDM"},{"code":"78600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":1190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM BRAIN W VASCULAR FLOW LT 4 VIEWS","code_information":[{"code":"Px00034110080","type":"CDM"},{"code":"78601","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":1190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRAIN IMAGE 4/PLUS VIEWS COMPLETE","code_information":[{"code":"Px00034110081","type":"CDM"},{"code":"78605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":1190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2722.0,"discounted_cash":1905.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRAIN VASCULAR FLOW IMAGING ONLY","code_information":[{"code":"Px00034110084","type":"CDM"},{"code":"78610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1625.0,"discounted_cash":1137.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM CSF FLOW CISTERNOGRAM","code_information":[{"code":"Px00034110085","type":"CDM"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1905.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CSF VENTRICULOGRAPHY","code_information":[{"code":"Px00034110086","type":"CDM"},{"code":"78635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2959.0,"discounted_cash":2071.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CSF SHUNT EVALUATION","code_information":[{"code":"Px00034110087","type":"CDM"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1192.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM CSF LEAK DETECTECTION","code_information":[{"code":"Px00034110089","type":"CDM"},{"code":"78650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1905.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NERVOUS SYSTEM EXAM UNLISTED","code_information":[{"code":"Px00034110090","type":"CDM"},{"code":"78699","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY W VASCULAR FLOW","code_information":[{"code":"Px00034110092","type":"CDM"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM KIDNEY VASC FLOW FUNC WO DRUG","code_information":[{"code":"Px00034110093","type":"CDM"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.0,"discounted_cash":1232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1800.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE MULTIPLE","code_information":[{"code":"Px00034110095","type":"CDM"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.0,"discounted_cash":1362.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URINARY BLADDER RESIDUAL STUDY","code_information":[{"code":"Px00034110098","type":"CDM"},{"code":"78730","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":500.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM","code_information":[{"code":"Px00034110099","type":"CDM"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM TESTES W VASCULAR FLOW","code_information":[{"code":"Px00034110100","type":"CDM"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":1465.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2017.0,"discounted_cash":1411.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2017.0,"discounted_cash":1411.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2401.0,"discounted_cash":1680.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5449.0,"discounted_cash":3814.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4528.0,"discounted_cash":3169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV INJ DRUG DX STUDY","code_information":[{"code":"Px00034110110","type":"CDM"},{"code":"78808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":1099.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE","code_information":[{"code":"Px00034110122","type":"CDM"},{"code":"78999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1647.0,"discounted_cash":1152.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM HEPATOBILIARY SYSTEM W DRUG","code_information":[{"code":"Px00034110132","type":"CDM"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1653.0,"discounted_cash":1157.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","code_information":[{"code":"Px00034110142","type":"CDM"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":600.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THYROID IMAGING WITH VASCULAR FLOW","code_information":[{"code":"Px00034110143","type":"CDM"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1769.0,"discounted_cash":1238.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1044.0,"discounted_cash":730.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2018.0,"discounted_cash":1412.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5764.0,"discounted_cash":4034.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6649.0,"discounted_cash":4654.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA CDM","code_information":[{"code":"Px00034110152","type":"CDM"},{"code":"78835","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":688.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPTYING SB TRANSIT","code_information":[{"code":"Px00034130006","type":"CDM"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1091.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NM GASTRIC EMPT SB/COL MULTIPLE DAYS","code_information":[{"code":"Px00034130007","type":"CDM"},{"code":"78266","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":1161.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIOPHARM THERAPY, BY ORAL ADMIN","code_information":[{"code":"Px00034210001","type":"CDM"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV RADIOPHARM ADMIN","code_information":[{"code":"Px00034210002","type":"CDM"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":653.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV MONOCLONAL AB THERAPY INFUSION","code_information":[{"code":"Px00034210005","type":"CDM"},{"code":"79403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.0,"discounted_cash":1444.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":790.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":632.0,"discounted_cash":442.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1265.0,"discounted_cash":885.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1636.0,"discounted_cash":1145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2011.0,"discounted_cash":1407.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3056.0,"discounted_cash":2139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2444.0,"discounted_cash":1710.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1630.0,"discounted_cash":1141.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT THORAX W/O DYE LUNG SCREENING","code_information":[{"code":"Px00035010012","type":"CDM"}],"standard_charges":[{"gross_charge":3972.0,"discounted_cash":2780.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3762.0,"discounted_cash":2633.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3010.0,"discounted_cash":2107.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2718.0,"discounted_cash":1902.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4126.0,"discounted_cash":2888.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3301.0,"discounted_cash":2310.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":3584.0,"discounted_cash":2508.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2868.0,"discounted_cash":2007.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":3991.0,"discounted_cash":2793.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3192.0,"discounted_cash":2234.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":5104.0,"discounted_cash":3572.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":4083.0,"discounted_cash":2858.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST","code_information":[{"code":"Px00035010027","type":"CDM"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010028","type":"CDM"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1794.0,"discounted_cash":1255.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART CONGENITAL W/3D IMAGE W/CONTRAST","code_information":[{"code":"Px00035010029","type":"CDM"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":2285.0,"discounted_cash":1599.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010030","type":"CDM"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":2316.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4569.0,"discounted_cash":3198.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3654.0,"discounted_cash":2557.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC 3D RENDER W/O POSTPROCESS","code_information":[{"code":"Px00035010032","type":"CDM"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":946.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC 3D RENDERING W/POSTPROCESS","code_information":[{"code":"Px00035010033","type":"CDM"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1352.0,"discounted_cash":946.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT SCAN FOLLOW-UP STUDY LIMITED","code_information":[{"code":"Px00035010034","type":"CDM"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":1038.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE STEREOTACTIC LOCALIZATION","code_information":[{"code":"Px00035010036","type":"CDM"},{"code":"77011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.0,"discounted_cash":1886.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT GUIDE PLCMT NEEDLE","code_information":[{"code":"Px00035010037","type":"CDM"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2840.0,"discounted_cash":1988.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2273.0,"discounted_cash":1591.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT GUIDE PLCMT RAD FIELD","code_information":[{"code":"Px00035010039","type":"CDM"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":948.0,"discounted_cash":663.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT BONE DENSITY AXIAL","code_information":[{"code":"Px00035010062","type":"CDM"},{"code":"77078","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":6734.0,"discounted_cash":4713.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":5387.0,"discounted_cash":3770.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT BODY SCOUT","code_information":[{"code":"Px00035010115","type":"CDM"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1728.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1383.0,"discounted_cash":968.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1636.0,"discounted_cash":1145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2011.0,"discounted_cash":1407.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1265.0,"discounted_cash":885.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1636.0,"discounted_cash":1145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2011.0,"discounted_cash":1407.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1265.0,"discounted_cash":885.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1636.0,"discounted_cash":1145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":3056.0,"discounted_cash":2139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2444.0,"discounted_cash":1710.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2074.0,"discounted_cash":1451.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2237.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2558.0,"discounted_cash":1790.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"discounted_cash":1350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1543.0,"discounted_cash":1080.1,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":2454.0,"discounted_cash":1717.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1964.0,"discounted_cash":1374.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.0,"discounted_cash":2118.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1630.0,"discounted_cash":1141.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2074.0,"discounted_cash":1451.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2237.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1630.0,"discounted_cash":1141.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2074.0,"discounted_cash":1451.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":2237.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3151.0,"discounted_cash":2205.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1630.0,"discounted_cash":1141.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2074.0,"discounted_cash":1451.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":3076.0,"discounted_cash":2153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":1199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1371.0,"discounted_cash":959.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.0,"discounted_cash":1199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1371.0,"discounted_cash":959.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2193.0,"discounted_cash":1535.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1755.0,"discounted_cash":1228.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT UPPR EXTREMITY W & W/O CONTRAST","code_information":[{"code":"Px00035210034","type":"CDM"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2718.0,"discounted_cash":1902.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2174.0,"discounted_cash":1521.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3151.0,"discounted_cash":2205.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2520.0,"discounted_cash":1764.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":1366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1562.0,"discounted_cash":1093.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2193.0,"discounted_cash":1535.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1755.0,"discounted_cash":1228.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.0,"discounted_cash":1758.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2009.0,"discounted_cash":1406.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3076.0,"discounted_cash":2153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2461.0,"discounted_cash":1722.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":6150.0,"discounted_cash":4305.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":4921.0,"discounted_cash":3444.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2038.0,"discounted_cash":1426.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":852.0,"discounted_cash":596.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ROBOTIC SURGICAL SYSTEM CDM","code_information":[{"code":"Px00036000019","type":"CDM"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":5287.0,"discounted_cash":3700.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":4555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":9951.0,"discounted_cash":6965.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":12527.0,"discounted_cash":8768.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":13578.0,"discounted_cash":9504.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":16036.0,"discounted_cash":11225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":2284.0,"discounted_cash":1598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":3231.0,"discounted_cash":2261.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":3913.0,"discounted_cash":2739.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":5409.0,"discounted_cash":3786.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":6908.0,"discounted_cash":4835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8852.0,"discounted_cash":6196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHANGE URETER STENT PERCUT","code_information":[{"code":"Px00036010061","type":"CDM"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":8158.0,"discounted_cash":5710.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"Px00036010064","type":"CDM"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1400.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"Px00036010069","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":3605.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJS TRANSFOR CER/THOR EA ADD LVL","code_information":[{"code":"Px00036010070","type":"CDM"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"Px00036010071","type":"CDM"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":3542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJS TRANSFOR L/S EA ADD LV COMP","code_information":[{"code":"Px00036010072","type":"CDM"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 3 LEV","code_information":[{"code":"Px00036010073","type":"CDM"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":713.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRONCHOSCOPY/NEEDLE BX EACH","code_information":[{"code":"Px00036010082","type":"CDM"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":4883.0,"discounted_cash":3418.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY OF LIVER","code_information":[{"code":"Px00036010104","type":"CDM"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3526.0,"discounted_cash":2468.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036010105","type":"CDM"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":6294.0,"discounted_cash":4405.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"Px00036010107","type":"CDM"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":752.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":1037.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAIN BREAST LESION ADD-ON","code_information":[{"code":"Px00036010112","type":"CDM"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BREAST X-RAY DUCTOGRAM OR GALACTOGRAM","code_information":[{"code":"Px00036010114","type":"CDM"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":322.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE PO BREAST CATH FOR RAD","code_information":[{"code":"Px00036010120","type":"CDM"},{"code":"19296","type":"HCPCS"}],"standard_charges":[{"gross_charge":8106.0,"discounted_cash":5674.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BX MUSCLE","code_information":[{"code":"Px00036010123","type":"CDM"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3734.0,"discounted_cash":2613.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00036010129","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00036010132","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"Px00036010133","type":"CDM"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":681.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":8655.0,"discounted_cash":6058.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":9237.0,"discounted_cash":6465.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":9836.0,"discounted_cash":6885.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":10475.0,"discounted_cash":7332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":11156.0,"discounted_cash":7809.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":11881.0,"discounted_cash":8316.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":12652.0,"discounted_cash":8856.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":13477.0,"discounted_cash":9433.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30868.0,"discounted_cash":21607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT EA ADD ARTERY","code_information":[{"code":"Px00036010189","type":"CDM"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":7808.0,"discounted_cash":5465.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACE STENT 1ST VEIN","code_information":[{"code":"Px00036010190","type":"CDM"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":30868.0,"discounted_cash":21607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL","code_information":[{"code":"Px00036010191","type":"CDM"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":6378.0,"discounted_cash":4464.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT VISCERA","code_information":[{"code":"Px00036010196","type":"CDM"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.0,"discounted_cash":2522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT PERI/RETRO","code_information":[{"code":"Px00036010197","type":"CDM"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.0,"discounted_cash":2522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC FLUID COLLECT TRNS/REC/VAG","code_information":[{"code":"Px00036010198","type":"CDM"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.0,"discounted_cash":2522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 PER MIN","code_information":[{"code":"Px00036010226","type":"CDM"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERV 1 EXT 1-4 MUSC","code_information":[{"code":"Px00036010236","type":"CDM"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY/REMOVAL LYMPH NODES OPEN, DEEP CERVICAL NODE(S)","code_information":[{"code":"Px00036010330","type":"CDM"},{"code":"38510","type":"HCPCS"}],"standard_charges":[{"gross_charge":7943.0,"discounted_cash":5560.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF SALIVARY GLAND, NEEDLE","code_information":[{"code":"Px00036010331","type":"CDM"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF PROSTATE","code_information":[{"code":"Px00036010343","type":"CDM"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":5603.0,"discounted_cash":3922.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE RADIATION THEAPY DEVICE/MARKER, PROSTATE","code_information":[{"code":"Px00036010344","type":"CDM"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3719.0,"discounted_cash":2603.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"Px00036010345","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF THYROID","code_information":[{"code":"Px00036010349","type":"CDM"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2609.0,"discounted_cash":1826.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2499.0,"discounted_cash":1749.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMPLANT NEUROELECTRODES PERQ EPIDURAL","code_information":[{"code":"Px00036010353","type":"CDM"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":18357.0,"discounted_cash":12849.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC PLEURAL DRAIN W/O IMAGE","code_information":[{"code":"Px00036010368","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"discounted_cash":2210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":8335.0,"discounted_cash":5834.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC THORACENTESIS NDL CATH WO IMAGE","code_information":[{"code":"Px00036010377","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY DIAGNOSTIC","code_information":[{"code":"Px00036010413","type":"CDM"}],"standard_charges":[{"gross_charge":7245.0,"discounted_cash":5071.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US GUIDED FINE NEEDLE ASP/BX","code_information":[{"code":"Px00036010482","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":989.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2508.0,"discounted_cash":1755.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMNIO (TERM)","code_information":[{"code":"Px00036010932","type":"CDM"}],"standard_charges":[{"gross_charge":1519.0,"discounted_cash":1063.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5817.0,"discounted_cash":4071.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-SECTION","code_information":[{"code":"Px00036010960","type":"CDM"}],"standard_charges":[{"gross_charge":26336.0,"discounted_cash":18435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC C-SECTION MULTI","code_information":[{"code":"Px00036010966","type":"CDM"}],"standard_charges":[{"gross_charge":31605.0,"discounted_cash":22123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR ELBOW X-RAY","code_information":[{"code":"Px00036011001","type":"CDM"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":643.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HIP ARTHROGRAM PROC","code_information":[{"code":"Px00036011002","type":"CDM"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECT SACROILIAC JOINT","code_information":[{"code":"Px00036011005","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2855.0,"discounted_cash":1998.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INS PCMKR GEN W EXIST MULT LEADS","code_information":[{"code":"Px00036012001","type":"CDM"},{"code":"33221","type":"HCPCS"}],"standard_charges":[{"gross_charge":12372.0,"discounted_cash":8660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMV & RPLC PCMK GEN SNG LEAD SYST","code_information":[{"code":"Px00036012002","type":"CDM"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":12609.0,"discounted_cash":8826.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMV & RPLC PCMK GEN DUAL LEAD SYS","code_information":[{"code":"Px00036012003","type":"CDM"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":13412.0,"discounted_cash":9388.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC PCMK GEN MULT LEAD SYS","code_information":[{"code":"Px00036012004","type":"CDM"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":14666.0,"discounted_cash":10266.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC ICD GEN SING LEAD SYST","code_information":[{"code":"Px00036012007","type":"CDM"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":32317.0,"discounted_cash":22621.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMV&RPLC ICD GEN MULT LEAD SYST","code_information":[{"code":"Px00036012009","type":"CDM"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":37188.0,"discounted_cash":26031.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL ARTERGM 1ST ORD COMP UNILAT","code_information":[{"code":"Px00036012010","type":"CDM"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":17565.0,"discounted_cash":12295.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL ARTERGM 1ST ORD COMP BILAT","code_information":[{"code":"Px00036012011","type":"CDM"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":18881.0,"discounted_cash":13216.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX CDM","code_information":[{"code":"Px00036100003","type":"CDM"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":8598.0,"discounted_cash":6018.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DSTR W NEUROL OTH PERIP NR","code_information":[{"code":"Px00036100072","type":"CDM"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1365.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ CDM","code_information":[{"code":"Px00036100077","type":"CDM"},{"code":"33997","type":"HCPCS"}],"standard_charges":[{"gross_charge":2604.0,"discounted_cash":1822.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5251.0,"discounted_cash":3675.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE","code_information":[{"code":"Px00036100087","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":958.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE","code_information":[{"code":"Px00036100131","type":"CDM"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":6405.0,"discounted_cash":4483.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SUTURES OR STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00036100183","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SUTURES & STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00036100184","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONTROL OF NOSEBLEED CDM","code_information":[{"code":"Px00036100189","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE CDM","code_information":[{"code":"Px00036100274","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN CDM","code_information":[{"code":"Px00036100275","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":4549.0,"discounted_cash":3184.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TEMPORARY CLOSURE EYELIDS SUTURE CDM","code_information":[{"code":"Px00036100276","type":"CDM"},{"code":"67875","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LARYNGOSCOPY W/FOREIGN BODY REMOVAL CDM","code_information":[{"code":"Px00036100277","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":6322.0,"discounted_cash":4425.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":14370.0,"discounted_cash":10059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":27856.0,"discounted_cash":19499.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":48245.0,"discounted_cash":33771.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST PLMT UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100324","type":"CDM"},{"code":"37285","type":"HCPCS"}],"standard_charges":[{"gross_charge":25071.0,"discounted_cash":17549.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100328","type":"CDM"},{"code":"37289","type":"HCPCS"}],"standard_charges":[{"gross_charge":14434.0,"discounted_cash":10103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST ATHRC UNI SF LES 1ST VSL CDM","code_information":[{"code":"Px00036100331","type":"CDM"},{"code":"37292","type":"HCPCS"}],"standard_charges":[{"gross_charge":48245.0,"discounted_cash":33771.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVSC EVASC TPVT ST ATHRC UNI SF LES EA ADDL VSL CDM","code_information":[{"code":"Px00036100332","type":"CDM"},{"code":"37293","type":"HCPCS"}],"standard_charges":[{"gross_charge":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1224.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABLATE PULM TUMOR PERQ CRYBL","code_information":[{"code":"Px00036110006","type":"CDM"},{"code":"32994","type":"HCPCS"}],"standard_charges":[{"gross_charge":14370.0,"discounted_cash":10059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6413.0,"discounted_cash":4489.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SEL CATH PLCM 3RD ORD","code_information":[{"code":"Px00036110037","type":"CDM"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":6682.0,"discounted_cash":4677.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"Px00036110042","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.0,"discounted_cash":1117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1891.0,"discounted_cash":1323.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FRENOTOMY LINGUAL CDM","code_information":[{"code":"Px00036110073","type":"CDM"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2882.0,"discounted_cash":2017.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW ASPIRATION","code_information":[{"code":"Px00036110101","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"Px00036110104","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":3736.0,"discounted_cash":2615.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"Px00036110105","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1052.0,"discounted_cash":736.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"Px00036110112","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":3684.0,"discounted_cash":2578.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4038.0,"discounted_cash":2826.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPLACE G/C TUBE PERC","code_information":[{"code":"Px00036110114","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2180.0,"discounted_cash":1526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"Px00036110116","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":2330.0,"discounted_cash":1631.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE","code_information":[{"code":"Px00036110117","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":1035.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":900.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR URETER X-RAY","code_information":[{"code":"Px00036110121","type":"CDM"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"Px00036110122","type":"CDM"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR MYELOGRAM","code_information":[{"code":"Px00036110126","type":"CDM"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":1850.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3440.0,"discounted_cash":2408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECT FOR SPINE DISK X-RAY CERVICAL/THORACIC","code_information":[{"code":"Px00036110128","type":"CDM"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3547.0,"discounted_cash":2482.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2855.0,"discounted_cash":1998.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC RENAL ART","code_information":[{"code":"Px00036110138","type":"CDM"},{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37162.0,"discounted_cash":26013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC VISCERAL","code_information":[{"code":"Px00036110139","type":"CDM"},{"code":"0235T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37162.0,"discounted_cash":26013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ABD AORTA","code_information":[{"code":"Px00036110140","type":"CDM"},{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37162.0,"discounted_cash":26013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL","code_information":[{"code":"Px00036110141","type":"CDM"},{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37162.0,"discounted_cash":26013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRLUML PERIP ATHRC ILIAC ART","code_information":[{"code":"Px00036110142","type":"CDM"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37162.0,"discounted_cash":26013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC NEEDLE BIOPSY CHEST LINING","code_information":[{"code":"Px00036110158","type":"CDM"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT PLEURAL CATH","code_information":[{"code":"Px00036110166","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":7099.0,"discounted_cash":4969.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"Px00036110167","type":"CDM"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":2321.0,"discounted_cash":1624.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"Px00036110168","type":"CDM"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART PACEMAKER","code_information":[{"code":"Px00036110169","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":13154.0,"discounted_cash":9207.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM HEART PACEMAKER","code_information":[{"code":"Px00036110170","type":"CDM"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":13701.0,"discounted_cash":9590.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION PERM AV PACER","code_information":[{"code":"Px00036110171","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":14712.0,"discounted_cash":10298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":6783.0,"discounted_cash":4748.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF PULSE GENERATOR","code_information":[{"code":"Px00036110175","type":"CDM"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":9142.0,"discounted_cash":6399.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUAL CHAMBER PACER","code_information":[{"code":"Px00036110176","type":"CDM"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":10578.0,"discounted_cash":7404.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UPGRADE OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110178","type":"CDM"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":16193.0,"discounted_cash":11335.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPOSITION PACING-IMPLANTABLE DEFIB LEAD","code_information":[{"code":"Px00036110179","type":"CDM"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":4931.0,"discounted_cash":3451.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT 1 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110180","type":"CDM"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":7316.0,"discounted_cash":5121.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT 2 ELECTRODE PM-IMPLANTABLE DEFIB","code_information":[{"code":"Px00036110181","type":"CDM"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":8044.0,"discounted_cash":5630.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR LEAD PACE- IMPLANTABLE DEFIB ONE","code_information":[{"code":"Px00036110182","type":"CDM"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5239.0,"discounted_cash":3667.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR LEAD PACE-IMPLANTABLE DEFIB DUAL","code_information":[{"code":"Px00036110183","type":"CDM"},{"code":"33220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5070.0,"discounted_cash":3549.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RELOCATION POCKET PACEMAKER","code_information":[{"code":"Px00036110184","type":"CDM"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3841.0,"discounted_cash":2688.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC L VENTRIC PACING LEAD ADD-ON","code_information":[{"code":"Px00036110187","type":"CDM"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":16683.0,"discounted_cash":11678.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"Px00036110189","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":3917.0,"discounted_cash":2741.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE PACER PERM SINGLE LEAD","code_information":[{"code":"Px00036110191","type":"CDM"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":3767.0,"discounted_cash":2636.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"Px00036110192","type":"CDM"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3824.0,"discounted_cash":2676.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE PULSE GENERATOR","code_information":[{"code":"Px00036110194","type":"CDM"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":5411.0,"discounted_cash":3787.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELTRD/INSERT PACE-DEFIB","code_information":[{"code":"Px00036110196","type":"CDM"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":33288.0,"discounted_cash":23301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR OF HEART WOUND","code_information":[{"code":"Px00036110199","type":"CDM"},{"code":"33300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5550.0,"discounted_cash":3885.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2190.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION","code_information":[{"code":"Px00036110241","type":"CDM"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2149.0,"discounted_cash":1504.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1613.0,"discounted_cash":1129.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL","code_information":[{"code":"Px00036110243","type":"CDM"},{"code":"10008","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.0,"discounted_cash":1265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2149.0,"discounted_cash":1504.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1808.0,"discounted_cash":1265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110248","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110249","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110250","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"Px00036110251","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00036110252","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1166.0,"discounted_cash":816.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG","code_information":[{"code":"Px00036110254","type":"CDM"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":31318.0,"discounted_cash":21922.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21566.0,"discounted_cash":15096.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"Px00036110257","type":"CDM"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":1281.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT PICC WO PORT PUMP LT 5 YR W IMG","code_information":[{"code":"Px00036110259","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3278.0,"discounted_cash":2294.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":4202.0,"discounted_cash":2941.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG","code_information":[{"code":"Px00036110262","type":"CDM"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":5388.0,"discounted_cash":3771.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS","code_information":[{"code":"Px00036110263","type":"CDM"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":9065.0,"discounted_cash":6345.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL IMPLANTABLE DEVICE","code_information":[{"code":"Px00036110366","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":5760.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"Px00036110367","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":4548.0,"discounted_cash":3183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"Px00036110385","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1152.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION EXT VENOGRAPHY","code_information":[{"code":"Px00036110386","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN VEIN","code_information":[{"code":"Px00036110388","type":"CDM"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":1771.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VENOUS PLACEMENT 1ST ORDER","code_information":[{"code":"Px00036110389","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3751.0,"discounted_cash":2625.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCT CATH 2ND VENOUS","code_information":[{"code":"Px00036110390","type":"CDM"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN HEART/PULM ARTERY","code_information":[{"code":"Px00036110391","type":"CDM"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":515.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RT/LT PULMONARY PLACEMENT","code_information":[{"code":"Px00036110392","type":"CDM"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":1033.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SELECT SEGMENTAL PULMONARY ART","code_information":[{"code":"Px00036110393","type":"CDM"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":887.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRO CATH EXTRM ART","code_information":[{"code":"Px00036110397","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":5200.0,"discounted_cash":3640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN AORTA","code_information":[{"code":"Px00036110402","type":"CDM"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5280.0,"discounted_cash":3696.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE CATHETER IN THOR/BRA ARTERY","code_information":[{"code":"Px00036110403","type":"CDM"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":4942.0,"discounted_cash":3459.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110404","type":"CDM"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":3921.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BRACHIOCEPHALIC ANGIO ADDT","code_information":[{"code":"Px00036110406","type":"CDM"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 1ST ORDER","code_information":[{"code":"Px00036110408","type":"CDM"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":7322.0,"discounted_cash":5125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 2ND ORDER","code_information":[{"code":"Px00036110409","type":"CDM"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":5689.0,"discounted_cash":3982.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO 3RD ORDER","code_information":[{"code":"Px00036110410","type":"CDM"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":6778.0,"discounted_cash":4744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABD/PELVIC ANGIO ADDT","code_information":[{"code":"Px00036110411","type":"CDM"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOVENOUS LASER 1ST VEIN","code_information":[{"code":"Px00036110414","type":"CDM"},{"code":"36478","type":"HCPCS"}],"standard_charges":[{"gross_charge":11970.0,"discounted_cash":8379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOVENOUS LASER VEIN ADDON","code_information":[{"code":"Px00036110415","type":"CDM"},{"code":"36479","type":"HCPCS"}],"standard_charges":[{"gross_charge":11970.0,"discounted_cash":8379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT TUNNELED CV CATH > 5","code_information":[{"code":"Px00036110425","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":12424.0,"discounted_cash":8696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5172.0,"discounted_cash":3620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR TUNNELED CV CATH","code_information":[{"code":"Px00036110437","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2791.0,"discounted_cash":1953.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6640.0,"discounted_cash":4648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5760.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5468.0,"discounted_cash":3827.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5097.0,"discounted_cash":3567.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPOSITION VENOUS CATHETER","code_information":[{"code":"Px00036110454","type":"CDM"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":7051.0,"discounted_cash":4935.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2211.0,"discounted_cash":1547.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE","code_information":[{"code":"Px00036110456","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00036110457","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT CATH UMBILICAL ARTERY NEWBORN CDM","code_information":[{"code":"Px00036110463","type":"CDM"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRIM ART MECH THROMBECTOMY","code_information":[{"code":"Px00036110476","type":"CDM"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":11281.0,"discounted_cash":7896.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRIM ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110477","type":"CDM"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":4874.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SEC ART M-THROMBECT ADD-ON","code_information":[{"code":"Px00036110478","type":"CDM"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":4874.0,"discounted_cash":3411.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VENOUS MECH THROMBECTOMY","code_information":[{"code":"Px00036110479","type":"CDM"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":11970.0,"discounted_cash":8379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VENOUS M-THROMBECTOMY ADD-ON","code_information":[{"code":"Px00036110480","type":"CDM"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":10406.0,"discounted_cash":7284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":627.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH STENT CCA W/EPS","code_information":[{"code":"Px00036110493","type":"CDM"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":22743.0,"discounted_cash":15920.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH STENT CCA W/O EPS","code_information":[{"code":"Px00036110494","type":"CDM"},{"code":"37216","type":"HCPCS"}],"standard_charges":[{"gross_charge":16864.0,"discounted_cash":11804.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC","code_information":[{"code":"Px00036110495","type":"CDM"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC W/STENT","code_information":[{"code":"Px00036110496","type":"CDM"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":14370.0,"discounted_cash":10059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC ADD-ON","code_information":[{"code":"Px00036110497","type":"CDM"},{"code":"37222","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ILIAC REVASC W/STENT ADD-ON","code_information":[{"code":"Px00036110498","type":"CDM"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/TLA","code_information":[{"code":"Px00036110499","type":"CDM"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVAS W/ATHER","code_information":[{"code":"Px00036110500","type":"CDM"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":27856.0,"discounted_cash":19499.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC W/STENT","code_information":[{"code":"Px00036110502","type":"CDM"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FEM/POPL REVASC STNT & ATHER","code_information":[{"code":"Px00036110503","type":"CDM"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":48245.0,"discounted_cash":33771.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/TLA","code_information":[{"code":"Px00036110504","type":"CDM"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/ATHER","code_information":[{"code":"Px00036110505","type":"CDM"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC W/STENT","code_information":[{"code":"Px00036110506","type":"CDM"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC STENT & ATHER","code_information":[{"code":"Px00036110507","type":"CDM"},{"code":"37231","type":"HCPCS"}],"standard_charges":[{"gross_charge":48245.0,"discounted_cash":33771.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC ADD-ON","code_information":[{"code":"Px00036110508","type":"CDM"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":13122.0,"discounted_cash":9185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIBPER REVASC W/ATHER ADD-ON","code_information":[{"code":"Px00036110509","type":"CDM"},{"code":"37233","type":"HCPCS"}],"standard_charges":[{"gross_charge":14434.0,"discounted_cash":10103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVSC OPN/PRQ TIB/PERO STENT","code_information":[{"code":"Px00036110510","type":"CDM"},{"code":"37234","type":"HCPCS"}],"standard_charges":[{"gross_charge":25071.0,"discounted_cash":17549.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TIB/PER REVASC STNT & ATHER","code_information":[{"code":"Px00036110511","type":"CDM"},{"code":"37235","type":"HCPCS"}],"standard_charges":[{"gross_charge":27858.0,"discounted_cash":19500.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG CDM","code_information":[{"code":"Px00036110530","type":"CDM"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":6454.0,"discounted_cash":4517.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN CDM","code_information":[{"code":"Px00036110531","type":"CDM"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6454.0,"discounted_cash":4517.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLICATION OF UNABOOT BIL","code_information":[{"code":"Px00036110555","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"Px00036110558","type":"CDM"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":1946.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1751.0,"discounted_cash":1225.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":18117.0,"discounted_cash":12681.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL ARTERY 2ND ORDE PLUS W/S&I BILATERAL","code_information":[{"code":"Px00036110584","type":"CDM"},{"code":"36254","type":"HCPCS"}],"standard_charges":[{"gross_charge":19430.0,"discounted_cash":13601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110585","type":"CDM"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":11912.0,"discounted_cash":8338.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL IVC FILTER W/WO S&I","code_information":[{"code":"Px00036110586","type":"CDM"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":6997.0,"discounted_cash":4897.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES CDM","code_information":[{"code":"Px00036110588","type":"CDM"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1392.0,"discounted_cash":974.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES CDM","code_information":[{"code":"Px00036110589","type":"CDM"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":2771.0,"discounted_cash":1939.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC COMPLEX DRAINAGE WOUND","code_information":[{"code":"Px00036110603","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":7999.0,"discounted_cash":5599.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"Px00036110611","type":"CDM"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3972.0,"discounted_cash":2780.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE LUNG CATHETER","code_information":[{"code":"Px00036110623","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2627.0,"discounted_cash":1838.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROAT SURGERY PROCEDURE","code_information":[{"code":"Px00036110644","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY PANCREAS","code_information":[{"code":"Px00036110659","type":"CDM"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2071.0,"discounted_cash":1449.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2685.0,"discounted_cash":1879.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY ABDOMINAL MASS","code_information":[{"code":"Px00036110664","type":"CDM"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3998.0,"discounted_cash":2798.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INS TUN IP CATH FOR DIAL OPN","code_information":[{"code":"Px00036110669","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":10170.0,"discounted_cash":7119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVE TUNNELED IP CATH","code_information":[{"code":"Px00036110670","type":"CDM"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":8028.0,"discounted_cash":5619.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"Px00036110671","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":2766.0,"discounted_cash":1936.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RENAL BIOPSY PERQ","code_information":[{"code":"Px00036110673","type":"CDM"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3997.0,"discounted_cash":2797.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF KIDNEY LESION","code_information":[{"code":"Px00036110677","type":"CDM"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":3807.0,"discounted_cash":2664.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.0,"discounted_cash":4069.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC UROLOGY SURGERY PROCEDURE","code_information":[{"code":"Px00036110692","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3922.0,"discounted_cash":2745.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TRANSCATH OCCLUSION NON-CNS","code_information":[{"code":"Px00036110699","type":"CDM"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":10937.0,"discounted_cash":7655.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAIN CEREBRO SPINAL FLUID","code_information":[{"code":"Px00036110702","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMPLANT SPINAL CANAL CATH","code_information":[{"code":"Px00036110709","type":"CDM"},{"code":"62350","type":"HCPCS"}],"standard_charges":[{"gross_charge":10141.0,"discounted_cash":7098.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ FEM SINGLE","code_information":[{"code":"Px00036110717","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2634.0,"discounted_cash":1843.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC N BLOCK OTHER PERIPHERAL","code_information":[{"code":"Px00036110718","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 1 LEV","code_information":[{"code":"Px00036110723","type":"CDM"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2724.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT C/T 2 LEV","code_information":[{"code":"Px00036110725","type":"CDM"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4316.0,"discounted_cash":3021.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 2 LEV","code_information":[{"code":"Px00036110730","type":"CDM"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ PARAVERT F JNT L/S 3 LEV","code_information":[{"code":"Px00036110732","type":"CDM"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":786.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7393.0,"discounted_cash":5175.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD PATCH","code_information":[{"code":"Px00036110802","type":"CDM"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACET INJ C/T SPINE SECOND LEVEL","code_information":[{"code":"Px00036110805","type":"CDM"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1587.0,"discounted_cash":1110.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FACET INJ C/T SPINE SINGLE LEVEL","code_information":[{"code":"Px00036110807","type":"CDM"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2724.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL INDWELL TUNNEL CATHETER","code_information":[{"code":"Px00036110819","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2627.0,"discounted_cash":1838.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION PULMONARY TUMOR","code_information":[{"code":"Px00036110913","type":"CDM"},{"code":"32998","type":"HCPCS"}],"standard_charges":[{"gross_charge":12262.0,"discounted_cash":8583.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"Px00036110934","type":"CDM"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3732.0,"discounted_cash":2612.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION LIVER TUMOR","code_information":[{"code":"Px00036110946","type":"CDM"},{"code":"47382","type":"HCPCS"}],"standard_charges":[{"gross_charge":11602.0,"discounted_cash":8121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC RADIO FREQ ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111013","type":"CDM"},{"code":"50592","type":"HCPCS"}],"standard_charges":[{"gross_charge":17381.0,"discounted_cash":12166.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERC CRYO ABLATION RENAL TUMOR","code_information":[{"code":"Px00036111014","type":"CDM"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":19043.0,"discounted_cash":13330.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOCRINE SURGERY PROCEDURE","code_information":[{"code":"Px00036111039","type":"CDM"},{"code":"60699","type":"HCPCS"}],"standard_charges":[{"gross_charge":12523.0,"discounted_cash":8766.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRACRANIAL ANGIOPLASTY","code_information":[{"code":"Px00036111048","type":"CDM"},{"code":"61630","type":"HCPCS"}],"standard_charges":[{"gross_charge":5965.0,"discounted_cash":4175.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ FORAMEN EPIDURAL CERVICAL/THORACIC BILATERAL","code_information":[{"code":"Px00036111073","type":"CDM"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":3605.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA","code_information":[{"code":"Px00036111114","type":"CDM"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4286.0,"discounted_cash":3000.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA","code_information":[{"code":"Px00036111115","type":"CDM"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.0,"discounted_cash":1449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","code_information":[{"code":"Px00036111116","type":"CDM"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":2454.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL","code_information":[{"code":"Px00036111117","type":"CDM"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1870.0,"discounted_cash":1309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":970.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3829.0,"discounted_cash":2680.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3158.0,"discounted_cash":2210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5060.0,"discounted_cash":3542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21051.0,"discounted_cash":14735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":31608.0,"discounted_cash":22125.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","code_information":[{"code":"Px00036111131","type":"CDM"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":44094.0,"discounted_cash":30865.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","code_information":[{"code":"Px00036111132","type":"CDM"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":44094.0,"discounted_cash":30865.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111133","type":"CDM"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":26856.0,"discounted_cash":18799.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"Px00036111134","type":"CDM"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":28276.0,"discounted_cash":19793.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","code_information":[{"code":"Px00036111135","type":"CDM"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":26051.0,"discounted_cash":18235.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","code_information":[{"code":"Px00036111136","type":"CDM"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":26051.0,"discounted_cash":18235.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","code_information":[{"code":"Px00036111137","type":"CDM"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":13774.0,"discounted_cash":9641.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8919.0,"discounted_cash":6243.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX","code_information":[{"code":"Px00036111139","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":8919.0,"discounted_cash":6243.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","code_information":[{"code":"Px00036111140","type":"CDM"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":9198.0,"discounted_cash":6438.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9198.0,"discounted_cash":6438.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","code_information":[{"code":"Px00036111150","type":"CDM"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":14331.0,"discounted_cash":10031.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION","code_information":[{"code":"Px00036111152","type":"CDM"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":12342.0,"discounted_cash":8639.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPOSITION VAD W/IMAGING DIFFERENT SESSION","code_information":[{"code":"Px00036111153","type":"CDM"},{"code":"33993","type":"HCPCS"}],"standard_charges":[{"gross_charge":19258.0,"discounted_cash":13480.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT CATH UMBILICAL VEIN NEWBORN CDM","code_information":[{"code":"Px00036111172","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION STEREO","code_information":[{"code":"Px00036111183","type":"CDM"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":4722.0,"discounted_cash":3305.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION STEREO","code_information":[{"code":"Px00036111184","type":"CDM"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2162.0,"discounted_cash":1513.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1138.0,"discounted_cash":796.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"Px00036111187","type":"CDM"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BX BREAST ADD LESION MR IMAG","code_information":[{"code":"Px00036111188","type":"CDM"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.0,"discounted_cash":1515.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DEVICE LOC BREAST 1ST IMAG","code_information":[{"code":"Px00036111189","type":"CDM"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1443.0,"discounted_cash":1010.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST 1ST MR GUIDE","code_information":[{"code":"Px00036111195","type":"CDM"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":2571.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV LOC BREAST ADD MR GUIDE","code_information":[{"code":"Px00036111196","type":"CDM"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":2362.0,"discounted_cash":1653.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3198.0,"discounted_cash":2238.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA SMALL W/US","code_information":[{"code":"Px00036111216","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.0,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US","code_information":[{"code":"Px00036111217","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":880.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1945.0,"discounted_cash":1361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17344.0,"discounted_cash":12140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":8972.0,"discounted_cash":6280.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":8972.0,"discounted_cash":6280.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE THORACIC","code_information":[{"code":"Px00036111225","type":"CDM"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":21797.0,"discounted_cash":15257.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE LUMBAR","code_information":[{"code":"Px00036111226","type":"CDM"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":21797.0,"discounted_cash":15257.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ VERTEBRAL AUGMENTATION USING DEVICE THORACIC/LUMBAR EA ADDL","code_information":[{"code":"Px00036111227","type":"CDM"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STENT PLACEMT ANTEGRADE CAROTID S&I","code_information":[{"code":"Px00036111232","type":"CDM"},{"code":"37218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3050.0,"discounted_cash":2135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ ABLTJ LVR CRYOABLATION","code_information":[{"code":"Px00036111233","type":"CDM"},{"code":"47383","type":"HCPCS"}],"standard_charges":[{"gross_charge":14120.0,"discounted_cash":9884.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION CERVICAL S&I","code_information":[{"code":"Px00036111234","type":"CDM"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":2890.0,"discounted_cash":2023.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION THORACIC S&I","code_information":[{"code":"Px00036111235","type":"CDM"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.0,"discounted_cash":2224.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3069.0,"discounted_cash":2148.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MYELOGRAPHY LUMBAR INJECTION 2 OR MORE REGIONS","code_information":[{"code":"Px00036111237","type":"CDM"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":3362.0,"discounted_cash":2353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME LTE 50 SQCM","code_information":[{"code":"Px00036111242","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":1036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1480.0,"discounted_cash":1036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAPHY","code_information":[{"code":"Px00036112004","type":"CDM"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION PROC FOR ANKLE ARTHROGRAM","code_information":[{"code":"Px00036112017","type":"CDM"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INS TEMP CARD ELECTRODES DUAL","code_information":[{"code":"Px00036112025","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":12215.0,"discounted_cash":8550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMPUTATION TOE INTERPHALANGEAL JOINT","code_information":[{"code":"Px00036112053","type":"CDM"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6741.0,"discounted_cash":4718.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING DME EQUIP LTE 50SQ CM","code_information":[{"code":"Px00036113066","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING DME EQUIP GT 50SQ CM","code_information":[{"code":"Px00036113067","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":505.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPOSITION IVC FILTER COMP","code_information":[{"code":"Px00036114007","type":"CDM"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6997.0,"discounted_cash":4897.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR TCAT MITRAL VALVE PERC APPRCH ADDL PROSTHESIS","code_information":[{"code":"Px00036114008","type":"CDM"},{"code":"33419","type":"HCPCS"}],"standard_charges":[{"gross_charge":17740.0,"discounted_cash":12418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REPAIR TCAT MITRAL VALVE PERC APPRCH INIT PROSTHESIS","code_information":[{"code":"Px00036114009","type":"CDM"},{"code":"33418","type":"HCPCS"}],"standard_charges":[{"gross_charge":17740.0,"discounted_cash":12418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABLAT EXTREM MECHAN 1ST","code_information":[{"code":"Px00036114029","type":"CDM"},{"code":"36473","type":"HCPCS"}],"standard_charges":[{"gross_charge":7961.0,"discounted_cash":5572.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ABLAT EXTREM MECHAN ADDL","code_information":[{"code":"Px00036114030","type":"CDM"},{"code":"36474","type":"HCPCS"}],"standard_charges":[{"gross_charge":3981.0,"discounted_cash":2786.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2866.0,"discounted_cash":2006.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/BALLN ANGIO","code_information":[{"code":"Px00036114034","type":"CDM"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":15127.0,"discounted_cash":10588.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRO NEEDLE/CATH DIALYSIS CIRCUIT W/STENT & ANGIO","code_information":[{"code":"Px00036114035","type":"CDM"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":30573.0,"discounted_cash":21401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALYSIS CIRCUIT","code_information":[{"code":"Px00036114036","type":"CDM"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":15127.0,"discounted_cash":10588.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRCUIT W/BALN","code_information":[{"code":"Px00036114037","type":"CDM"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":30573.0,"discounted_cash":21401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THROMBECT DIALY CIRC W/STNT AN","code_information":[{"code":"Px00036114038","type":"CDM"},{"code":"36906","type":"HCPCS"}],"standard_charges":[{"gross_charge":46339.0,"discounted_cash":32437.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLASTY BALLN DIALY CIRC","code_information":[{"code":"Px00036114039","type":"CDM"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":23170.0,"discounted_cash":16219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLACE STENT DIALY CIRC W/ANGIO","code_information":[{"code":"Px00036114040","type":"CDM"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":23170.0,"discounted_cash":16219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EMBOLIZATION/OCCLU DIALY CIRC","code_information":[{"code":"Px00036114041","type":"CDM"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":23170.0,"discounted_cash":16219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BALLN TRNSL 1ST ART","code_information":[{"code":"Px00036114042","type":"CDM"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":15127.0,"discounted_cash":10588.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL ADDL ART","code_information":[{"code":"Px00036114043","type":"CDM"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":7564.0,"discounted_cash":5294.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNSL 1ST VEIN","code_information":[{"code":"Px00036114044","type":"CDM"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":15127.0,"discounted_cash":10588.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANGIOPLAST BLLN TRNS ADDL VEIN","code_information":[{"code":"Px00036114045","type":"CDM"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":7564.0,"discounted_cash":5294.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ INTERLAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00036114046","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ INTRALAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00036114049","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":3202.0,"discounted_cash":2241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ CATH PLCMENT CONT INFUS OR BOLUS C/T W/IMAG","code_information":[{"code":"Px00036114050","type":"CDM"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":3202.0,"discounted_cash":2241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","code_information":[{"code":"Px00036114054","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2959.0,"discounted_cash":2071.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2644.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ DEV SOFT TISS ADDL IMAG","code_information":[{"code":"Px00036119072","type":"CDM"},{"code":"10036","type":"HCPCS"}],"standard_charges":[{"gross_charge":2644.0,"discounted_cash":1850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","code_information":[{"code":"Px00036119078","type":"CDM"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":2256.0,"discounted_cash":1579.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, EXTERNAL","code_information":[{"code":"Px00036119080","type":"CDM"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":9211.0,"discounted_cash":6447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLMT BILIARY DRAINAGE CATH, INTERNAL-EXTERNAL","code_information":[{"code":"Px00036119081","type":"CDM"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":9211.0,"discounted_cash":6447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE BILIARY DRG CATH","code_information":[{"code":"Px00036119083","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":6875.0,"discounted_cash":4812.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL BILIARY DRG CATH","code_information":[{"code":"Px00036119084","type":"CDM"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":2097.0,"discounted_cash":1467.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERQ PLMT BILE DUCT STENT, NEW ACCESS","code_information":[{"code":"Px00036119086","type":"CDM"},{"code":"47539","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":1030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM, NEW ACCESS","code_information":[{"code":"Px00036119092","type":"CDM"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":2020.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2886.0,"discounted_cash":2020.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"Px00036119094","type":"CDM"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":5381.0,"discounted_cash":3766.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"Px00036119097","type":"CDM"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9494.0,"discounted_cash":6645.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BALLOON DILATE URTRL STRIX","code_information":[{"code":"Px00036119103","type":"CDM"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1533.0,"discounted_cash":1073.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":846.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":864.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":805.0,"discounted_cash":563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":582.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039000017","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2246.0,"discounted_cash":1572.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA SPLIT EA UNIT","code_information":[{"code":"Px00039010005","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOLOGOUS BLOOD PROCESS WB","code_information":[{"code":"Px00039010009","type":"CDM"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":452.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOLOGOUS WHOLE BLOOD FOR TRANSFUSION","code_information":[{"code":"Px00039010012","type":"CDM"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED PED PACK","code_information":[{"code":"Px00039010016","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010022","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WASHED RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010024","type":"CDM"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":595.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":1190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2246.0,"discounted_cash":1572.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC IRRADIATED","code_information":[{"code":"Px00039010034","type":"CDM"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUC CMV NEG EA UNIT","code_information":[{"code":"Px00039010038","type":"CDM"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLT PHERESIS HLA MATCHED LEUK REDUCED","code_information":[{"code":"Px00039010039","type":"CDM"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2445.0,"discounted_cash":1711.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLT PHERESIS LR IRR CMV NEG","code_information":[{"code":"Px00039010040","type":"CDM"},{"code":"P9053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.0,"discounted_cash":1525.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLT PHERESIS LR CMV NEG","code_information":[{"code":"Px00039010042","type":"CDM"},{"code":"P9055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":973.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKORED IRRAD CMV NEG EA","code_information":[{"code":"Px00039010044","type":"CDM"},{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":513.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2246.0,"discounted_cash":1572.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG BIL W CAD","code_information":[{"code":"Px00040110004","type":"CDM"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":545.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAMMO DIAG UNI W CAD","code_information":[{"code":"Px00040110005","type":"CDM"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":489.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":562.0,"discounted_cash":393.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC OPHTH US B W/NON-QUANT A","code_information":[{"code":"Px00040210003","type":"CDM"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":562.0,"discounted_cash":393.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":604.0,"discounted_cash":422.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":934.0,"discounted_cash":653.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":709.0,"discounted_cash":496.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":776.0,"discounted_cash":543.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1010.0,"discounted_cash":707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":645.0,"discounted_cash":451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":670.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":609.0,"discounted_cash":426.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US SPINAL CANAL","code_information":[{"code":"Px00040210013","type":"CDM"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.0,"discounted_cash":833.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":756.0,"discounted_cash":529.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB LT 14 WKS SINGLE FETUS CDM","code_information":[{"code":"Px00040210014","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":820.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":750.0,"discounted_cash":525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB LT 14 WKS ADDL FETUS CDM","code_information":[{"code":"Px00040210015","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1505.0,"discounted_cash":1053.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":960.0,"discounted_cash":672.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":825.0,"discounted_cash":577.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB DETAILED SINGLE FETUS CDM","code_information":[{"code":"Px00040210018","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1575.0,"discounted_cash":1102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1004.0,"discounted_cash":702.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB DETAILED ADDL FETUS CDM","code_information":[{"code":"Px00040210019","type":"CDM"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US OB NUCHAL MEASUREMENT 1 GEST CDM","code_information":[{"code":"Px00040210020","type":"CDM"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US OB NUCHAL MEASUREMENT ADD GEST CDM","code_information":[{"code":"Px00040210021","type":"CDM"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":878.0,"discounted_cash":614.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":562.0,"discounted_cash":393.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":442.0,"discounted_cash":309.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":704.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":642.0,"discounted_cash":449.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":760.0,"discounted_cash":532.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/O NST CDM","code_information":[{"code":"Px00040210026","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":760.0,"discounted_cash":532.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO EXAM OF FETAL HEART CDM","code_information":[{"code":"Px00040210029","type":"CDM"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":3188.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF FETAL HEART FOLLOW-UP OR REPEAT","code_information":[{"code":"Px00040210030","type":"CDM"},{"code":"76826","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":850.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF FETAL HEART W/DOPPLER CDM","code_information":[{"code":"Px00040210031","type":"CDM"},{"code":"76827","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":1000.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO OF FETAL HEART W/DOPPLER F/U OR REPEAT CDM","code_information":[{"code":"Px00040210032","type":"CDM"},{"code":"76828","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":1000.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":604.0,"discounted_cash":422.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO EXAM UTERUS","code_information":[{"code":"Px00040210034","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":1596.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":733.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":668.0,"discounted_cash":467.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US TRANSRECTAL PROSTATE VOLUME","code_information":[{"code":"Px00040210038","type":"CDM"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":521.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":497.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":455.0,"discounted_cash":318.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":419.0,"discounted_cash":293.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US INFANT HIPS DYNAMIC","code_information":[{"code":"Px00040210045","type":"CDM"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":4383.0,"discounted_cash":3068.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US INFANT HIPS STATIC","code_information":[{"code":"Px00040210046","type":"CDM"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":1003.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":480.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":275.0,"discounted_cash":192.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210052","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":989.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":902.0,"discounted_cash":631.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO GUIDE FOR AMNIOCENTESIS CDM","code_information":[{"code":"Px00040210053","type":"CDM"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTERSTITIAL RADIOTHERAPY","code_information":[{"code":"Px00040210056","type":"CDM"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":2528.0,"discounted_cash":1769.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":2217.0,"discounted_cash":1551.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1414.0,"discounted_cash":989.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1575.0,"discounted_cash":1102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1004.0,"discounted_cash":702.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US UMBILICAL ARTERY ECHO CDM","code_information":[{"code":"Px00040210076","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":1023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":934.0,"discounted_cash":653.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1010.0,"discounted_cash":707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":645.0,"discounted_cash":451.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":419.0,"discounted_cash":293.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":417.0,"discounted_cash":291.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":417.0,"discounted_cash":291.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":415.0,"discounted_cash":290.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ULTRASOUND ELASTOGRAPHY PARENCHYMA","code_information":[{"code":"Px00040210150","type":"CDM"},{"code":"76981","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":481.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PET IMAGE W CT LIMITED","code_information":[{"code":"Px00040410009","type":"CDM"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":8415.0,"discounted_cash":5890.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PET IMAGE W CT SKULL MID THIGH","code_information":[{"code":"Px00040410010","type":"CDM"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":8415.0,"discounted_cash":5890.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PET IMAGE W CT WHOLE BODY","code_information":[{"code":"Px00040410011","type":"CDM"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":8415.0,"discounted_cash":5890.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PET CT BONE SCAN","code_information":[{"code":"Px00040410017","type":"CDM"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":8415.0,"discounted_cash":5890.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RECON CTA FOR SURG PLAN","code_information":[{"code":"Px00040910001","type":"CDM"},{"code":"G0288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":735.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD SAMPLING CAPILLARY CDM","code_information":[{"code":"Px00041010004","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL CATHETER DRAW - ESTABLISHED - CDM","code_information":[{"code":"Px00041010005","type":"CDM"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":501.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ","code_information":[{"code":"Px00041010010","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT CDM","code_information":[{"code":"Px00041010015","type":"CDM"},{"code":"94772","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.0,"discounted_cash":1528.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":824.0,"discounted_cash":576.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2482.0,"discounted_cash":1737.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":855.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB GROUP CDM","code_information":[{"code":"Px00041010331","type":"CDM"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB RESP FUNCTION, INDIV CDM","code_information":[{"code":"Px00041010332","type":"CDM"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATHETER ASPIRATION NASOTRACHEAL SPX","code_information":[{"code":"Px00041010357","type":"CDM"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB STRENGTH/ENDURANCE, INDIV CDM","code_information":[{"code":"Px00041010363","type":"CDM"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SURFACTANT ADMINISTRATION W/O INTUBATION (LMA/LISA) CDM","code_information":[{"code":"Px00041044444","type":"CDM"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTRAPULMONARY SURFACTANT ADMINISTJ THROUGH TUBE PHYS/QHP CDM","code_information":[{"code":"Px00041210001","type":"CDM"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH","code_information":[{"code":"Px00041210007","type":"CDM"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STRAPPING SHOULDER","code_information":[{"code":"Px00042010073","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"Px00042010080","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":558.0,"discounted_cash":390.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":529.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL CAPACITIES EVAL TEST 1045M (L AND I)","code_information":[{"code":"Px00042010101","type":"CDM"},{"code":"1045M","type":"HCPCS"}],"standard_charges":[{"gross_charge":2253.0,"discounted_cash":1577.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOFEEDBACK TRAIN ANY METH","code_information":[{"code":"Px00042010102","type":"CDM"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLICATION MODALITY 1 OR MORE AREAS HOT/COLD PACKS CDM","code_information":[{"code":"Px00042010109","type":"CDM"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS VASOPNEUMATIC DEVICES","code_information":[{"code":"Px00042010114","type":"CDM"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPLICATION MODALITY 1 OR MORE AREAS WHIRLPOOL","code_information":[{"code":"Px00042010117","type":"CDM"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS IONTOPHORESIS EA 15 MIN","code_information":[{"code":"Px00042010125","type":"CDM"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AQUATIC THERAPY/EXERCISES - 15 MIN","code_information":[{"code":"Px00042010141","type":"CDM"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC PROCEDURES GROUP 2 OR MORE INDIVIDUALS","code_information":[{"code":"Px00042010153","type":"CDM"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS","code_information":[{"code":"Px00042010166","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00042010173","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","code_information":[{"code":"Px00042010182","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":722.0,"discounted_cash":505.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL PERFORMANCE TEST - FUNC CAPACITY EACH 15MINS CDM","code_information":[{"code":"Px00042010249","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELEC STIM UNATTENDED TO 1 OR MORE AREAS OTHER THAN WOUND CARE","code_information":[{"code":"Px00042010270","type":"CDM"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REVIEW JOB DESC/ANALYSIS RPT","code_information":[{"code":"Px00042410038","type":"CDM"},{"code":"99080","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"discounted_cash":565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SELF CARE MNGMENT TRAINING - ADL","code_information":[{"code":"Px00043010013","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WORK HARDENING - INIT 2 HRS","code_information":[{"code":"Px00043010017","type":"CDM"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC WORK HARDENING/CONDITIONING EACH ADDL HOUR","code_information":[{"code":"Px00043010019","type":"CDM"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSISTIVE TECHNOLOGY ASSESS","code_information":[{"code":"Px00043010029","type":"CDM"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":461.0,"discounted_cash":322.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING","code_information":[{"code":"Px00044010028","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE","code_information":[{"code":"Px00044010062","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OTORHINOLARYNGOLOGICAL SERVICE/PX","code_information":[{"code":"Px00044010069","type":"CDM"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ASSESSMENT OF APHASIA PER HOUR","code_information":[{"code":"Px00044010074","type":"CDM"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM","code_information":[{"code":"Px00044010076","type":"CDM"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00044410054","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6727.0,"discounted_cash":4708.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4570.0,"discounted_cash":3199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3673.0,"discounted_cash":2571.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7169.0,"discounted_cash":5018.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2202.0,"discounted_cash":1541.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3620.0,"discounted_cash":2534.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7104.0,"discounted_cash":4972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9199.0,"discounted_cash":6439.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2499.0,"discounted_cash":1749.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8015.0,"discounted_cash":5610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4244.0,"discounted_cash":2970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3725.0,"discounted_cash":2607.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9162.0,"discounted_cash":6413.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1852.0,"discounted_cash":1296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5043.0,"discounted_cash":3530.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":822.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":2804.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5293.0,"discounted_cash":3705.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4622.0,"discounted_cash":3235.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2111.0,"discounted_cash":1477.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":838.0,"discounted_cash":586.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6916.0,"discounted_cash":4841.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2888.0,"discounted_cash":2021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2301.0,"discounted_cash":1610.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1367.0,"discounted_cash":956.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2369.0,"discounted_cash":1658.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1458.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2068.0,"discounted_cash":1447.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2258.0,"discounted_cash":1580.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5694.0,"discounted_cash":3985.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4960.0,"discounted_cash":3472.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5251.0,"discounted_cash":3675.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL CDM","code_information":[{"code":"Px00045000065","type":"CDM"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.0,"discounted_cash":679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6644.0,"discounted_cash":4650.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10170.0,"discounted_cash":7119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6687.0,"discounted_cash":4680.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6772.0,"discounted_cash":4740.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6875.0,"discounted_cash":4812.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8000.0,"discounted_cash":5600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1711.0,"discounted_cash":1197.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1711.0,"discounted_cash":1197.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4064.0,"discounted_cash":2844.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3769.0,"discounted_cash":2638.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3177.0,"discounted_cash":2223.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6504.0,"discounted_cash":4552.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9209.0,"discounted_cash":6446.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":7441.0,"discounted_cash":5208.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6741.0,"discounted_cash":4718.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3922.0,"discounted_cash":2745.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4122.0,"discounted_cash":2885.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4156.0,"discounted_cash":2909.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9903.0,"discounted_cash":6932.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9039.0,"discounted_cash":6327.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":8919.0,"discounted_cash":6243.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6385.0,"discounted_cash":4469.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3099.0,"discounted_cash":2169.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3099.0,"discounted_cash":2169.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3910.0,"discounted_cash":2737.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1976.0,"discounted_cash":1383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7659.0,"discounted_cash":5361.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9821.0,"discounted_cash":6874.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1230.0,"discounted_cash":861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":610.0,"discounted_cash":427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED 68020 INCISION CONJUNCTIVA DRAINAGE OF CYST CDM","code_information":[{"code":"Px00045000125","type":"CDM"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1549.0,"discounted_cash":1084.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1395.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5106.0,"discounted_cash":3574.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1466.0,"discounted_cash":1026.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":806.0,"discounted_cash":564.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1021.0,"discounted_cash":714.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":806.0,"discounted_cash":564.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC US ED OPTH B W/NON-QUANT A CDM","code_information":[{"code":"Px00045000146","type":"CDM"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":9856.0,"discounted_cash":6899.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4082.0,"discounted_cash":2857.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12190.0,"discounted_cash":8533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5248.0,"discounted_cash":3673.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4272.0,"discounted_cash":2990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11378.0,"discounted_cash":7964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5468.0,"discounted_cash":3827.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4303.0,"discounted_cash":3012.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3191.0,"discounted_cash":2233.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":716.0,"discounted_cash":501.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6520.0,"discounted_cash":4564.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5919.0,"discounted_cash":4143.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2347.0,"discounted_cash":1642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1392.0,"discounted_cash":974.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2771.0,"discounted_cash":1939.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6085.0,"discounted_cash":4259.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1103.0,"discounted_cash":772.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10677.0,"discounted_cash":7473.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3321.0,"discounted_cash":2324.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2768.0,"discounted_cash":1937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1152.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1859.0,"discounted_cash":1301.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4860.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5650.0,"discounted_cash":3955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1783.0,"discounted_cash":1248.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3315.0,"discounted_cash":2320.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3771.0,"discounted_cash":2639.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1800.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3156.0,"discounted_cash":2209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2970.0,"discounted_cash":2079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1751.0,"discounted_cash":1225.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17965.0,"discounted_cash":12575.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12090.0,"discounted_cash":8463.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12651.0,"discounted_cash":8855.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1972.0,"discounted_cash":1380.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4389.0,"discounted_cash":3072.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4171.0,"discounted_cash":2919.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12499.0,"discounted_cash":8749.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11222.0,"discounted_cash":7855.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11860.0,"discounted_cash":8302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5534.0,"discounted_cash":3873.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":962.0,"discounted_cash":673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":970.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6783.0,"discounted_cash":4748.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1488.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1646.0,"discounted_cash":1152.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12424.0,"discounted_cash":8696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1663.0,"discounted_cash":1164.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5172.0,"discounted_cash":3620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1224.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":897.0,"discounted_cash":627.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3817.0,"discounted_cash":2671.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5520.0,"discounted_cash":3864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2923.0,"discounted_cash":2046.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":580.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3233.0,"discounted_cash":2263.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1596.0,"discounted_cash":1117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3736.0,"discounted_cash":2615.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1376.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4015.0,"discounted_cash":2810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3025.0,"discounted_cash":2117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5268.0,"discounted_cash":3687.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1394.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":5967.0,"discounted_cash":4176.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1522.0,"discounted_cash":1065.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3104.0,"discounted_cash":2172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2873.0,"discounted_cash":2011.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4547.0,"discounted_cash":3182.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9015.0,"discounted_cash":6310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1664.0,"discounted_cash":1164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2451.0,"discounted_cash":1715.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":361.0,"discounted_cash":252.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5882.0,"discounted_cash":4117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":6024.0,"discounted_cash":4216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7393.0,"discounted_cash":5175.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3687.0,"discounted_cash":2580.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":11003.0,"discounted_cash":7702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":8501.0,"discounted_cash":5950.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1200.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED SEXUAL ASSAULT EXAM CDM","code_information":[{"code":"Px00045010130","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.0,"discounted_cash":1612.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1448.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4790.0,"discounted_cash":3353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":7857.0,"discounted_cash":5499.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1002.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1002.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":641.0,"discounted_cash":448.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12216.0,"discounted_cash":8551.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6021.0,"discounted_cash":4214.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":519.0,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5994.0,"discounted_cash":4195.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":639.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":799.0,"discounted_cash":559.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7313.0,"discounted_cash":5119.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8187.0,"discounted_cash":5730.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":11536.0,"discounted_cash":8075.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10282.0,"discounted_cash":7197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":780.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5018.0,"discounted_cash":3512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10382.0,"discounted_cash":7267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10068.0,"discounted_cash":7047.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1115.0,"discounted_cash":780.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1652.0,"discounted_cash":1156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4725.0,"discounted_cash":3307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6312.0,"discounted_cash":4418.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9105.0,"discounted_cash":6373.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":851.0,"discounted_cash":595.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6094.0,"discounted_cash":4265.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5817.0,"discounted_cash":4071.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1450.0,"discounted_cash":1015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2303.0,"discounted_cash":1612.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3226.0,"discounted_cash":2258.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2012.0,"discounted_cash":1408.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2721.0,"discounted_cash":1904.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2175.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6378.0,"discounted_cash":4464.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10131.0,"discounted_cash":7091.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6684.0,"discounted_cash":4678.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5849.0,"discounted_cash":4094.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10759.0,"discounted_cash":7531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":647.0,"discounted_cash":452.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8719.0,"discounted_cash":6103.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6879.0,"discounted_cash":4815.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4318.0,"discounted_cash":3022.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4036.0,"discounted_cash":2825.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":769.0,"discounted_cash":538.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6937.0,"discounted_cash":4855.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7846.0,"discounted_cash":5492.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7955.0,"discounted_cash":5568.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12505.0,"discounted_cash":8753.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":886.0,"discounted_cash":620.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4777.0,"discounted_cash":3343.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":701.0,"discounted_cash":490.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1108.0,"discounted_cash":775.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3138.0,"discounted_cash":2196.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2604.0,"discounted_cash":1822.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":927.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4629.0,"discounted_cash":3240.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6613.0,"discounted_cash":4629.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2903.0,"discounted_cash":2032.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2374.0,"discounted_cash":1661.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1920.0,"discounted_cash":1344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":661.0,"discounted_cash":462.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5258.0,"discounted_cash":3680.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7107.0,"discounted_cash":4974.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7085.0,"discounted_cash":4959.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9453.0,"discounted_cash":6617.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1363.0,"discounted_cash":954.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1485.0,"discounted_cash":1039.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5455.0,"discounted_cash":3818.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":962.0,"discounted_cash":673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3062.0,"discounted_cash":2143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1018.0,"discounted_cash":712.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5525.0,"discounted_cash":3867.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6382.0,"discounted_cash":4467.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9328.0,"discounted_cash":6529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6193.0,"discounted_cash":4335.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2979.0,"discounted_cash":2085.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1775.0,"discounted_cash":1242.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3646.0,"discounted_cash":2552.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2656.0,"discounted_cash":1859.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":845.0,"discounted_cash":591.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1451.0,"discounted_cash":1015.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8465.0,"discounted_cash":5925.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7999.0,"discounted_cash":5599.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.0,"discounted_cash":1015.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3619.0,"discounted_cash":2533.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4602.0,"discounted_cash":3221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6939.0,"discounted_cash":4857.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4653.0,"discounted_cash":3257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5217.0,"discounted_cash":3651.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1344.0,"discounted_cash":940.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2748.0,"discounted_cash":1923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":726.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3384.0,"discounted_cash":2368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3387.0,"discounted_cash":2370.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1683.0,"discounted_cash":1178.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2566.0,"discounted_cash":1796.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3372.0,"discounted_cash":2360.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4352.0,"discounted_cash":3046.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":748.0,"discounted_cash":523.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":873.0,"discounted_cash":611.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":916.0,"discounted_cash":641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":939.0,"discounted_cash":657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1580.0,"discounted_cash":1106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8685.0,"discounted_cash":6079.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1763.0,"discounted_cash":1234.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2092.0,"discounted_cash":1464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":719.0,"discounted_cash":503.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1014.0,"discounted_cash":709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1314.0,"discounted_cash":919.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1912.0,"discounted_cash":1338.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1028.0,"discounted_cash":719.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1033.0,"discounted_cash":723.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1437.0,"discounted_cash":1005.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3907.0,"discounted_cash":2734.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7655.0,"discounted_cash":5358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":955.0,"discounted_cash":668.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1062.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1187.0,"discounted_cash":830.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1319.0,"discounted_cash":923.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1789.0,"discounted_cash":1252.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6972.0,"discounted_cash":4880.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2016.0,"discounted_cash":1411.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1490.0,"discounted_cash":1043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7278.0,"discounted_cash":5094.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1282.0,"discounted_cash":897.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1042.0,"discounted_cash":729.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":686.0,"discounted_cash":480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15012.0,"discounted_cash":10508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5393.0,"discounted_cash":3775.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":631.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6808.0,"discounted_cash":4765.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4143.0,"discounted_cash":2900.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1262.0,"discounted_cash":883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":6111.0,"discounted_cash":4277.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5576.0,"discounted_cash":3903.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6051.0,"discounted_cash":4235.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":755.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8419.0,"discounted_cash":5893.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":4161.0,"discounted_cash":2912.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":510.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6030.0,"discounted_cash":4221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6989.0,"discounted_cash":4892.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6625.0,"discounted_cash":4637.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1275.0,"discounted_cash":892.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15362.0,"discounted_cash":10753.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4193.0,"discounted_cash":2935.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2143.0,"discounted_cash":1500.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1092.0,"discounted_cash":764.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":949.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":7938.0,"discounted_cash":5556.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6200.0,"discounted_cash":4340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3000.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6204.0,"discounted_cash":4342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6750.0,"discounted_cash":4725.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14245.0,"discounted_cash":9971.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9271.0,"discounted_cash":6489.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":10417.0,"discounted_cash":7291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":5452.0,"discounted_cash":3816.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6283.0,"discounted_cash":4398.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":531.0,"discounted_cash":371.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":1085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":9312.0,"discounted_cash":6518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4866.0,"discounted_cash":3406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":6884.0,"discounted_cash":4818.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":839.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1499.0,"discounted_cash":1049.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6361.0,"discounted_cash":4452.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1367.0,"discounted_cash":956.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4716.0,"discounted_cash":3301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5211.0,"discounted_cash":3647.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6492.0,"discounted_cash":4544.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":631.0,"discounted_cash":441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5176.0,"discounted_cash":3623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1921.0,"discounted_cash":1344.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3669.0,"discounted_cash":2568.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2521.0,"discounted_cash":1764.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5228.0,"discounted_cash":3659.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1348.0,"discounted_cash":943.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4402.0,"discounted_cash":3081.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":851.0,"discounted_cash":595.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4583.0,"discounted_cash":3208.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":6109.0,"discounted_cash":4276.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":963.0,"discounted_cash":674.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5538.0,"discounted_cash":3876.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6391.0,"discounted_cash":4473.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1899.0,"discounted_cash":1329.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1418.0,"discounted_cash":992.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2241.0,"discounted_cash":1568.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1668.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7594.0,"discounted_cash":5315.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5312.0,"discounted_cash":3718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4757.0,"discounted_cash":3329.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2761.0,"discounted_cash":1932.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2609.0,"discounted_cash":1826.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6852.0,"discounted_cash":4796.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5027.0,"discounted_cash":3518.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15736.0,"discounted_cash":11015.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3974.0,"discounted_cash":2781.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5103.0,"discounted_cash":3572.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":702.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":902.0,"discounted_cash":631.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2955.0,"discounted_cash":2068.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1310.0,"discounted_cash":917.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":923.0,"discounted_cash":646.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4503.0,"discounted_cash":3152.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.0,"discounted_cash":1948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1182.0,"discounted_cash":827.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8598.0,"discounted_cash":6018.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":716.0,"discounted_cash":501.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5484.0,"discounted_cash":3838.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7641.0,"discounted_cash":5348.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5749.0,"discounted_cash":4024.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6949.0,"discounted_cash":4864.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5537.0,"discounted_cash":3875.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2114.0,"discounted_cash":1479.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5210.0,"discounted_cash":3647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12570.0,"discounted_cash":8799.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14245.0,"discounted_cash":9971.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4272.0,"discounted_cash":2990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":867.0,"discounted_cash":606.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9761.0,"discounted_cash":6832.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"discounted_cash":913.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":10417.0,"discounted_cash":7291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6241.0,"discounted_cash":4368.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1203.0,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2973.0,"discounted_cash":2081.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1330.0,"discounted_cash":931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1226.0,"discounted_cash":858.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":499.0,"discounted_cash":349.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3582.0,"discounted_cash":2507.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2562.0,"discounted_cash":1793.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2562.0,"discounted_cash":1793.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":917.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3051.0,"discounted_cash":2135.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1993.0,"discounted_cash":1395.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":6971.0,"discounted_cash":4879.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6298.0,"discounted_cash":4408.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2623.0,"discounted_cash":1836.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1468.0,"discounted_cash":1027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7358.0,"discounted_cash":5150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3600.0,"discounted_cash":2520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1683.0,"discounted_cash":1178.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2344.0,"discounted_cash":1640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.0,"discounted_cash":1670.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2208.0,"discounted_cash":1545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9532.0,"discounted_cash":6672.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18192.0,"discounted_cash":12734.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2785.0,"discounted_cash":1949.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1891.0,"discounted_cash":1323.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2731.0,"discounted_cash":1911.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":17707.0,"discounted_cash":12394.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":15704.0,"discounted_cash":10992.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11886.0,"discounted_cash":8320.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12460.0,"discounted_cash":8722.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6866.0,"discounted_cash":4806.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":14300.0,"discounted_cash":10010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10196.0,"discounted_cash":7137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17701.0,"discounted_cash":12390.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12188.0,"discounted_cash":8531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":8628.0,"discounted_cash":6039.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":9948.0,"discounted_cash":6963.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7689.0,"discounted_cash":5382.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":7186.0,"discounted_cash":5030.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":14505.0,"discounted_cash":10153.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8014.0,"discounted_cash":5609.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":7715.0,"discounted_cash":5400.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5029.0,"discounted_cash":3520.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10160.0,"discounted_cash":7112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5410.0,"discounted_cash":3787.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4816.0,"discounted_cash":3371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7361.0,"discounted_cash":5152.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6138.0,"discounted_cash":4296.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3218.0,"discounted_cash":2252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":7883.0,"discounted_cash":5518.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5312.0,"discounted_cash":3718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6977.0,"discounted_cash":4883.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10910.0,"discounted_cash":7637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5480.0,"discounted_cash":3836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6547.0,"discounted_cash":4582.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2634.0,"discounted_cash":1843.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2550.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":3775.0,"discounted_cash":2642.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4238.0,"discounted_cash":2966.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":298.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2138.0,"discounted_cash":1496.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8767.0,"discounted_cash":6136.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1406.0,"discounted_cash":984.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5919.0,"discounted_cash":4143.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":9229.0,"discounted_cash":6460.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1440.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10543.0,"discounted_cash":7380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4610.0,"discounted_cash":3227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7335.0,"discounted_cash":5134.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":13743.0,"discounted_cash":9620.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":8243.0,"discounted_cash":5770.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6254.0,"discounted_cash":4377.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5058.0,"discounted_cash":3540.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8162.0,"discounted_cash":5713.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5218.0,"discounted_cash":3652.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1166.0,"discounted_cash":816.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1168.0,"discounted_cash":817.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1231.0,"discounted_cash":861.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1482.0,"discounted_cash":1037.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9446.0,"discounted_cash":6612.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5378.0,"discounted_cash":3764.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8688.0,"discounted_cash":6081.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":707.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12215.0,"discounted_cash":8550.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8938.0,"discounted_cash":6256.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":23217.0,"discounted_cash":16251.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5760.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5097.0,"discounted_cash":3567.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1262.0,"discounted_cash":883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2834.0,"discounted_cash":1983.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3684.0,"discounted_cash":2578.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2212.0,"discounted_cash":1548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3626.0,"discounted_cash":2538.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":917.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6092.0,"discounted_cash":4264.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16345.0,"discounted_cash":11441.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3516.0,"discounted_cash":2461.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18250.0,"discounted_cash":12775.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2558.0,"discounted_cash":1790.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12345.0,"discounted_cash":8641.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12675.0,"discounted_cash":8872.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17868.0,"discounted_cash":12507.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6990.0,"discounted_cash":4893.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7281.0,"discounted_cash":5096.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":912.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2112.0,"discounted_cash":1478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3751.0,"discounted_cash":2625.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5122.0,"discounted_cash":3585.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3405.0,"discounted_cash":2383.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6079.0,"discounted_cash":4255.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1348.0,"discounted_cash":943.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1479.0,"discounted_cash":1035.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2330.0,"discounted_cash":1631.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1418.0,"discounted_cash":992.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":712.0,"discounted_cash":498.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3829.0,"discounted_cash":2680.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3158.0,"discounted_cash":2210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5060.0,"discounted_cash":3542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2855.0,"discounted_cash":1998.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1652.0,"discounted_cash":1156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8599.0,"discounted_cash":6019.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7294.0,"discounted_cash":5105.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6140.0,"discounted_cash":4298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3765.0,"discounted_cash":2635.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":679.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4624.0,"discounted_cash":3236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1258.0,"discounted_cash":880.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2367.0,"discounted_cash":1656.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":8972.0,"discounted_cash":6280.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":8972.0,"discounted_cash":6280.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":869.0,"discounted_cash":608.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21798.0,"discounted_cash":15258.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4422.0,"discounted_cash":3095.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2724.0,"discounted_cash":1906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7495.0,"discounted_cash":5246.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4415.0,"discounted_cash":3090.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4681.0,"discounted_cash":3276.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7799.0,"discounted_cash":5459.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1209.0,"discounted_cash":846.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1395.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":917.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2627.0,"discounted_cash":1838.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2649.0,"discounted_cash":1854.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5200.0,"discounted_cash":3640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4202.0,"discounted_cash":2941.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7136.0,"discounted_cash":4995.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5612.0,"discounted_cash":3928.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1357.0,"discounted_cash":949.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5267.0,"discounted_cash":3686.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3686.0,"discounted_cash":2580.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6523.0,"discounted_cash":4566.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8757.0,"discounted_cash":6129.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3645.0,"discounted_cash":2551.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2180.0,"discounted_cash":1526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5814.0,"discounted_cash":4069.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5550.0,"discounted_cash":3885.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1283.0,"discounted_cash":898.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1945.0,"discounted_cash":1361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1041.0,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5049.0,"discounted_cash":3534.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6786.0,"discounted_cash":4750.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5876.0,"discounted_cash":4113.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1450.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4272.0,"discounted_cash":2990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5108.0,"discounted_cash":3575.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4622.0,"discounted_cash":3235.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5172.0,"discounted_cash":3620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7099.0,"discounted_cash":4969.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4559.0,"discounted_cash":3191.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15819.0,"discounted_cash":11073.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5360.0,"discounted_cash":3752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8367.0,"discounted_cash":5856.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3278.0,"discounted_cash":2294.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5400.0,"discounted_cash":3780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6640.0,"discounted_cash":4648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3580.0,"discounted_cash":2506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8327.0,"discounted_cash":5828.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4856.0,"discounted_cash":3399.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2988.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":720.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5773.0,"discounted_cash":4041.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7324.0,"discounted_cash":5126.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":5365.0,"discounted_cash":3755.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3333.0,"discounted_cash":2333.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2533.0,"discounted_cash":1773.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7272.0,"discounted_cash":5090.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":9173.0,"discounted_cash":6421.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5149.0,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2730.0,"discounted_cash":1911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2400.0,"discounted_cash":1680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":468.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9177.0,"discounted_cash":6423.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3875.0,"discounted_cash":2712.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7528.0,"discounted_cash":5269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":847.0,"discounted_cash":592.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6739.0,"discounted_cash":4717.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4616.0,"discounted_cash":3231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":838.0,"discounted_cash":586.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":7461.0,"discounted_cash":5222.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":732.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":8329.0,"discounted_cash":5830.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4063.0,"discounted_cash":2844.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7951.0,"discounted_cash":5565.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":942.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5817.0,"discounted_cash":4071.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2907.0,"discounted_cash":2034.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":683.0,"discounted_cash":478.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8703.0,"discounted_cash":6092.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2959.0,"discounted_cash":2071.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3202.0,"discounted_cash":2241.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":767.0,"discounted_cash":536.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3039.0,"discounted_cash":2127.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2691.0,"discounted_cash":1883.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7686.0,"discounted_cash":5380.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6312.0,"discounted_cash":4418.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3845.0,"discounted_cash":2691.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":5238.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":687.0,"discounted_cash":480.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":576.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":623.0,"discounted_cash":436.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1235.0,"discounted_cash":864.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9405.0,"discounted_cash":6583.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":693.0,"discounted_cash":485.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":933.0,"discounted_cash":653.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":302.0,"discounted_cash":211.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":791.0,"discounted_cash":553.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":529.0,"discounted_cash":370.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9162.0,"discounted_cash":6413.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":637.0,"discounted_cash":445.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7110.0,"discounted_cash":4977.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2049.0,"discounted_cash":1434.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":448.0,"discounted_cash":313.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2602.0,"discounted_cash":1821.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2791.0,"discounted_cash":1953.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TELEHEALTH FACILITY FEE CDM","code_information":[{"code":"Px00045011097","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3193.0,"discounted_cash":2235.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":694.0,"discounted_cash":485.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":815.0,"discounted_cash":570.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5018.0,"discounted_cash":3512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10924.0,"discounted_cash":7646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7800.0,"discounted_cash":5460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4692.0,"discounted_cash":3284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6178.0,"discounted_cash":4324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5629.0,"discounted_cash":3940.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6663.0,"discounted_cash":4664.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":754.0,"discounted_cash":527.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":887.0,"discounted_cash":620.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":602.0,"discounted_cash":421.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1456.0,"discounted_cash":1019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10965.0,"discounted_cash":7675.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8493.0,"discounted_cash":5945.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":695.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":747.0,"discounted_cash":522.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7555.0,"discounted_cash":5288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":770.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3978.0,"discounted_cash":2784.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":573.0,"discounted_cash":401.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":541.0,"discounted_cash":378.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":739.0,"discounted_cash":517.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":635.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":657.0,"discounted_cash":459.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":565.0,"discounted_cash":395.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":337.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6563.0,"discounted_cash":4594.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4347.0,"discounted_cash":3042.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":781.0,"discounted_cash":546.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":604.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3484.0,"discounted_cash":2438.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4910.0,"discounted_cash":3437.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00045013191","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.0,"discounted_cash":552.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1319.0,"discounted_cash":923.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5231.0,"discounted_cash":3661.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7270.0,"discounted_cash":5089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":5679.0,"discounted_cash":3975.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":746.0,"discounted_cash":522.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5813.0,"discounted_cash":4069.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":4900.0,"discounted_cash":3430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":1008.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1421.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6460.0,"discounted_cash":4522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2821.0,"discounted_cash":1974.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16141.0,"discounted_cash":11298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10105.0,"discounted_cash":7073.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4844.0,"discounted_cash":3390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2201.0,"discounted_cash":1540.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2124.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2451.0,"discounted_cash":1715.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1057.0,"discounted_cash":739.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4101.0,"discounted_cash":2870.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":890.0,"discounted_cash":623.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1116.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2320.0,"discounted_cash":1624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1014.0,"discounted_cash":709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4272.0,"discounted_cash":2990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8168.0,"discounted_cash":5717.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1406.0,"discounted_cash":984.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1378.0,"discounted_cash":964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8059.0,"discounted_cash":5641.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3178.0,"discounted_cash":2224.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4017.0,"discounted_cash":2811.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4721.0,"discounted_cash":3304.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":796.0,"discounted_cash":557.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":695.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":501.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17167.0,"discounted_cash":12016.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2458.0,"discounted_cash":1720.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.0,"discounted_cash":1722.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":638.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7978.0,"discounted_cash":5584.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3787.0,"discounted_cash":2650.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4198.0,"discounted_cash":2938.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17886.0,"discounted_cash":12520.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8232.0,"discounted_cash":5762.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4066.0,"discounted_cash":2846.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2190.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OFFICE CONSULTATION LEVEL 3","code_information":[{"code":"Px00045610001","type":"CDM"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OFFICE CONSULTATION LEVEL 4","code_information":[{"code":"Px00045610002","type":"CDM"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":651.0,"discounted_cash":455.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG","code_information":[{"code":"Px00046010011","type":"CDM"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY EXERCISE TESTING","code_information":[{"code":"Px00046010040","type":"CDM"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":455.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)","code_information":[{"code":"Px00046010090","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SCREENING TEST PURE TONE AIR ONLY","code_information":[{"code":"Px00047010002","type":"CDM"},{"code":"92551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PURE TONE AUDIOMETRY AIR ONLY","code_information":[{"code":"Px00047010003","type":"CDM"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POSITIONAL NYSTAGMUS TEST","code_information":[{"code":"Px00047010025","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2160.0,"discounted_cash":1512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD CDM","code_information":[{"code":"Px00047110025","type":"CDM"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":13908.0,"discounted_cash":9735.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":3114.0,"discounted_cash":2179.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP","code_information":[{"code":"Px00048010057","type":"CDM"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.0,"discounted_cash":1330.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1686.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":3854.0,"discounted_cash":2697.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2751.0,"discounted_cash":1925.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC DOP ECHOCARD COLOR FLOW VELOCITY MAPPING CDM","code_information":[{"code":"Px00048010067","type":"CDM"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":595.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":607.0,"discounted_cash":424.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO TEE IMAGE INTERP & REPT","code_information":[{"code":"Px00048010071","type":"CDM"},{"code":"93314","type":"HCPCS"}],"standard_charges":[{"gross_charge":2261.0,"discounted_cash":1582.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":865.0,"discounted_cash":605.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":619.0,"discounted_cash":433.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":5094.0,"discounted_cash":3565.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3640.0,"discounted_cash":2548.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO TTE 2D W/WO CONTRAST DOP COLOR","code_information":[{"code":"Px00048010077","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":5848.0,"discounted_cash":4093.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ","code_information":[{"code":"Px00048010078","type":"CDM"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":3678.0,"discounted_cash":2574.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PM DEVICE PROGR EVAL DUAL","code_information":[{"code":"Px00048010082","type":"CDM"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM","code_information":[{"code":"Px00048010088","type":"CDM"},{"code":"93286","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRE-OP ICD DEVICE EVAL","code_information":[{"code":"Px00048010089","type":"CDM"},{"code":"93287","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTERROG DEVICE EVAL HEART","code_information":[{"code":"Px00048010091","type":"CDM"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR","code_information":[{"code":"Px00048010122","type":"CDM"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":991.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM","code_information":[{"code":"Px00048010157","type":"CDM"},{"code":"93260","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB","code_information":[{"code":"Px00048010158","type":"CDM"},{"code":"93261","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO TEE GUIDE (TAVR, PULMONARY OR MITRAL VALVE) W/CONTRAST","code_information":[{"code":"Px00048010159","type":"CDM"},{"code":"93355","type":"HCPCS"}],"standard_charges":[{"gross_charge":2169.0,"discounted_cash":1518.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"Px00048010160","type":"CDM"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":10052.0,"discounted_cash":7036.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TCAT INS 2CHMBR LDLS PM RA CDM","code_information":[{"code":"Px00048100077","type":"CDM"},{"code":"0796T","type":"HCPCS"}],"standard_charges":[{"gross_charge":45450.0,"discounted_cash":31815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL","code_information":[{"code":"Px00048100080","type":"CDM"},{"code":"0823T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37170.0,"discounted_cash":26019.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TCAT INSJ PERM 2CHMBR LDLS PM R VENTR PM COMPNT","code_information":[{"code":"Px00048100089","type":"CDM"},{"code":"0797T","type":"HCPCS"}],"standard_charges":[{"gross_charge":37130.0,"discounted_cash":25991.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT","code_information":[{"code":"Px00048110004","type":"CDM"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":29786.0,"discounted_cash":20850.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-AO NDGFT RPT","code_information":[{"code":"Px00048110005","type":"CDM"},{"code":"34702","type":"HCPCS"}],"standard_charges":[{"gross_charge":34004.0,"discounted_cash":23802.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"Px00048110006","type":"CDM"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":32525.0,"discounted_cash":22767.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-UNILAC NDGFT RPT","code_information":[{"code":"Px00048110007","type":"CDM"},{"code":"34704","type":"HCPCS"}],"standard_charges":[{"gross_charge":37403.0,"discounted_cash":26182.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"Px00048110008","type":"CDM"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":35778.0,"discounted_cash":25044.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"Px00048110010","type":"CDM"},{"code":"34706","type":"HCPCS"}],"standard_charges":[{"gross_charge":47317.0,"discounted_cash":33121.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC SINGLE","code_information":[{"code":"Px00048110011","type":"CDM"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":24570.0,"discounted_cash":17199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":21324.0,"discounted_cash":14926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR DRUG ELUTING STENT PERC ATHER SINGLE","code_information":[{"code":"Px00048110013","type":"CDM"},{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"gross_charge":23204.0,"discounted_cash":16242.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":22326.0,"discounted_cash":15628.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":22290.0,"discounted_cash":15603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30148.0,"discounted_cash":21103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","code_information":[{"code":"Px00048110025","type":"CDM"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":15837.0,"discounted_cash":11085.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1891.0,"discounted_cash":1323.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","code_information":[{"code":"Px00048110027","type":"CDM"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":24329.0,"discounted_cash":17030.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH","code_information":[{"code":"Px00048110028","type":"CDM"},{"code":"92925","type":"HCPCS"}],"standard_charges":[{"gross_charge":9439.0,"discounted_cash":6607.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML W/ANGIO ONE ART/BRNCH","code_information":[{"code":"Px00048110029","type":"CDM"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":19379.0,"discounted_cash":13565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML W/ANGIO ADDL ART/BRNCH","code_information":[{"code":"Px00048110030","type":"CDM"},{"code":"92929","type":"HCPCS"}],"standard_charges":[{"gross_charge":19379.0,"discounted_cash":13565.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT PERC TRLUML ATH/ANGIO ONE ART/BRNCH","code_information":[{"code":"Px00048110031","type":"CDM"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":19737.0,"discounted_cash":13815.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT BYPASS GRAFT TRLUML REVASC ONE VESSEL","code_information":[{"code":"Px00048110033","type":"CDM"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":22020.0,"discounted_cash":15414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30868.0,"discounted_cash":21607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":26260.0,"discounted_cash":18382.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT COR STENT TRLUML CHRONIC OCCLUS REVASC ADDL VSL","code_information":[{"code":"Px00048110037","type":"CDM"},{"code":"92944","type":"HCPCS"}],"standard_charges":[{"gross_charge":16124.0,"discounted_cash":11286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX NONCMPND SCLRSNT 1 VEIN","code_information":[{"code":"Px00048110052","type":"CDM"},{"code":"36465","type":"HCPCS"}],"standard_charges":[{"gross_charge":7460.0,"discounted_cash":5222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS","code_information":[{"code":"Px00048110053","type":"CDM"},{"code":"36466","type":"HCPCS"}],"standard_charges":[{"gross_charge":7460.0,"discounted_cash":5222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN","code_information":[{"code":"Px00048110054","type":"CDM"},{"code":"36482","type":"HCPCS"}],"standard_charges":[{"gross_charge":13652.0,"discounted_cash":9556.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","code_information":[{"code":"Px00048110101","type":"CDM"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":6615.0,"discounted_cash":4630.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL","code_information":[{"code":"Px00048110106","type":"CDM"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":7058.0,"discounted_cash":4940.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":5039.0,"discounted_cash":3527.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL","code_information":[{"code":"Px00048110107","type":"CDM"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":4392.0,"discounted_cash":3074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3138.0,"discounted_cash":2196.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"Px00048110141","type":"CDM"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":11063.0,"discounted_cash":7744.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEFT HRT CATH W/VENTRCLGRPHY","code_information":[{"code":"Px00048110142","type":"CDM"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":14050.0,"discounted_cash":9835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":14050.0,"discounted_cash":9835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":14245.0,"discounted_cash":9971.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":14245.0,"discounted_cash":9971.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":25308.0,"discounted_cash":17715.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I","code_information":[{"code":"Px00048110147","type":"CDM"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":26996.0,"discounted_cash":18897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":18433.0,"discounted_cash":12903.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":20124.0,"discounted_cash":14086.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":18433.0,"discounted_cash":12903.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":20124.0,"discounted_cash":14086.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE CDM","code_information":[{"code":"Px00048110152","type":"CDM"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":9498.0,"discounted_cash":6648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT","code_information":[{"code":"Px00048110153","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXERCISE W/HEMODYNAMIC MEAS","code_information":[{"code":"Px00048110154","type":"CDM"},{"code":"93464","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.0,"discounted_cash":1259.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION FLOW DIRECTED CATHETER FOR MONITORING","code_information":[{"code":"Px00048110156","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":13742.0,"discounted_cash":9619.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF HEART LINING","code_information":[{"code":"Px00048110158","type":"CDM"},{"code":"93505","type":"HCPCS"}],"standard_charges":[{"gross_charge":6517.0,"discounted_cash":4561.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECT CONGENITAL CARD CATH","code_information":[{"code":"Px00048110183","type":"CDM"},{"code":"93563","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.0,"discounted_cash":1094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX DRG CGEN C-CATHJ SLCTV OPACIFICATION S&I","code_information":[{"code":"Px00048110184","type":"CDM"},{"code":"93564","type":"HCPCS"}],"standard_charges":[{"gross_charge":2117.0,"discounted_cash":1481.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECT L VENTR/ATRIAL ANGIO","code_information":[{"code":"Px00048110185","type":"CDM"},{"code":"93565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2988.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I","code_information":[{"code":"Px00048110186","type":"CDM"},{"code":"93566","type":"HCPCS"}],"standard_charges":[{"gross_charge":2988.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3329.0,"discounted_cash":2330.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY CDM","code_information":[{"code":"Px00048110188","type":"CDM"},{"code":"93568","type":"HCPCS"}],"standard_charges":[{"gross_charge":3756.0,"discounted_cash":2629.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":5131.0,"discounted_cash":3591.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3665.0,"discounted_cash":2565.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2338.0,"discounted_cash":1636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1670.0,"discounted_cash":1169.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"Px00048110224","type":"CDM"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1543.0,"discounted_cash":1080.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","code_information":[{"code":"Px00048110298","type":"CDM"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":73967.0,"discounted_cash":51776.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI","code_information":[{"code":"Px00048110300","type":"CDM"},{"code":"93895","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF LEFT HEART VENT","code_information":[{"code":"Px00048110433","type":"CDM"},{"code":"33988","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.0,"discounted_cash":980.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL OF LEFT HEART VENT","code_information":[{"code":"Px00048110434","type":"CDM"},{"code":"33989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.0,"discounted_cash":980.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK MITRAL","code_information":[{"code":"Px00048110435","type":"CDM"},{"code":"93590","type":"HCPCS"}],"standard_charges":[{"gross_charge":46339.0,"discounted_cash":32437.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK AORTIC","code_information":[{"code":"Px00048110436","type":"CDM"},{"code":"93591","type":"HCPCS"}],"standard_charges":[{"gross_charge":46339.0,"discounted_cash":32437.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PTC CLOS PARA LEAK EA ADDL","code_information":[{"code":"Px00048110437","type":"CDM"},{"code":"93592","type":"HCPCS"}],"standard_charges":[{"gross_charge":23170.0,"discounted_cash":16219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC TCAT INS 2CHMBR LDLS PM CMPL","code_information":[{"code":"Px00048110444","type":"CDM"},{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"gross_charge":44125.0,"discounted_cash":30887.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIO STRESS TEST SUPV INTERP & REPT","code_information":[{"code":"Px00048210001","type":"CDM"},{"code":"93015","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1378.0,"discounted_cash":964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIO STRESS TEST MEDICINE","code_information":[{"code":"Px00048210004","type":"CDM"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":964.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS INCL CONNECTION/RECORDING& DISCONNECTION","code_information":[{"code":"Px00048210012","type":"CDM"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1079.0,"discounted_cash":755.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EVENT MONITOR ATTENDED 30 DAY, CONNECTION/RECORDING& DISCONNECTION","code_information":[{"code":"Px00048210019","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECG/MONITORING AND ANALYSIS PT HOME ACTIVATED UP TO 30DAYS","code_information":[{"code":"Px00048210020","type":"CDM"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMBULATORY BP RECORDING","code_information":[{"code":"Px00048210023","type":"CDM"},{"code":"93786","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AMBULATORY BP ANALYSIS","code_information":[{"code":"Px00048210024","type":"CDM"},{"code":"93788","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2941.0,"discounted_cash":2058.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3542.0,"discounted_cash":2479.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2530.0,"discounted_cash":1771.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":560.0,"discounted_cash":392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO DOPPLER PULSE CONTIN LTD","code_information":[{"code":"Px00048310013","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":391.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":398.0,"discounted_cash":278.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC ECHO STRESS W/INTERP REPT & MONITOR","code_information":[{"code":"Px00048310016","type":"CDM"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":3580.0,"discounted_cash":2506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1826.0,"discounted_cash":1278.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO TEE W/WO CONTRAST CONTINUOUS","code_information":[{"code":"Px00048310023","type":"CDM"},{"code":"C8927","type":"HCPCS"}],"standard_charges":[{"gross_charge":5954.0,"discounted_cash":4167.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4723.0,"discounted_cash":3306.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE W OR W/O FOL W/CONT CONGENITAL COMPLETE","code_information":[{"code":"Px00048310042","type":"CDM"},{"code":"C8921","type":"HCPCS"}],"standard_charges":[{"gross_charge":2391.0,"discounted_cash":1673.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00051000011","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00051000012","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00051000015","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00051000016","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00051000017","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00051000018","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXCISION OF MOUTH LESION","code_information":[{"code":"Px00051010093","type":"CDM"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4884.0,"discounted_cash":3418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CYSTOSCOPY","code_information":[{"code":"Px00051010098","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2175.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1  CDM","code_information":[{"code":"Px00051010105","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INIT PM E/M NEW PAT INF","code_information":[{"code":"Px00051010316","type":"CDM"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INIT PM E/M NEW PAT 1-4 YRS","code_information":[{"code":"Px00051010317","type":"CDM"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT NEW AGE 5-11","code_information":[{"code":"Px00051010318","type":"CDM"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FAC OFFICE VISIT-NP 12-17 YRS","code_information":[{"code":"Px00051010319","type":"CDM"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT NEW AGE 18-39","code_information":[{"code":"Px00051010320","type":"CDM"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT NEW AGE 40-64","code_information":[{"code":"Px00051010321","type":"CDM"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INIT PM E/M NEW PAT 65+ YRS","code_information":[{"code":"Px00051010322","type":"CDM"},{"code":"99387","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT EST AGE 1-4","code_information":[{"code":"Px00051010324","type":"CDM"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT EST AGE 5-11","code_information":[{"code":"Px00051010325","type":"CDM"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT EST AGE 12-17","code_information":[{"code":"Px00051010326","type":"CDM"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT EST AGE 18-39","code_information":[{"code":"Px00051010327","type":"CDM"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PREV VISIT EST AGE 40-64","code_information":[{"code":"Px00051010328","type":"CDM"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PER PM REEVAL EST PAT 65+ YR","code_information":[{"code":"Px00051010329","type":"CDM"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION CDM","code_information":[{"code":"Px00051010401","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM","code_information":[{"code":"Px00051010409","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM  CDM","code_information":[{"code":"Px00051010411","type":"CDM"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010417","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2768.0,"discounted_cash":1937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14  CDM","code_information":[{"code":"Px00051010446","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SCREENING TEST VISUAL ACUITY","code_information":[{"code":"Px00051010510","type":"CDM"},{"code":"99173","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VISIT TO DETERM LDCT ELIG","code_information":[{"code":"Px00051010519","type":"CDM"},{"code":"G0296","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT  CDM","code_information":[{"code":"Px00051010607","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DESTRUCTION PREMALIGNANT LESION 1ST CDM","code_information":[{"code":"Px00051010627","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR","code_information":[{"code":"Px00051010648","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ABBR BREAST SCREEN BILATERAL W WO CONTRAST LIMITED","code_information":[{"code":"Px00061000003","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.0,"discounted_cash":1197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI WHOLE BODY SCREENING W/WO CONTRAST","code_information":[{"code":"Px00061000008","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3250.0,"discounted_cash":2275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W CONTRAST","code_information":[{"code":"Px00061010005","type":"CDM"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1276.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":2026.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":2004.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":3002.0,"discounted_cash":2101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":3457.0,"discounted_cash":2419.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":2004.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":3013.0,"discounted_cash":2109.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.0,"discounted_cash":2260.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE EXTENDED","code_information":[{"code":"Px00061010016","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.0,"discounted_cash":1953.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":2193.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010022","type":"CDM"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS W/O DYE LIMITED","code_information":[{"code":"Px00061010030","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS W CONTRAST","code_information":[{"code":"Px00061010038","type":"CDM"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4591.0,"discounted_cash":3213.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4020.0,"discounted_cash":2814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY W DYE","code_information":[{"code":"Px00061010056","type":"CDM"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":2468.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT W CONTRAST","code_information":[{"code":"Px00061010057","type":"CDM"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3938.0,"discounted_cash":2756.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2903.0,"discounted_cash":2032.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3396.0,"discounted_cash":2377.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3227.0,"discounted_cash":2258.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3227.0,"discounted_cash":2258.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4467.0,"discounted_cash":3126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5841.0,"discounted_cash":4088.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":3574.0,"discounted_cash":2501.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":3574.0,"discounted_cash":2501.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W/O DYE LIMITED","code_information":[{"code":"Px00061010084","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":2564.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4591.0,"discounted_cash":3213.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH","code_information":[{"code":"Px00061010090","type":"CDM"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC W/STRESS IMG","code_information":[{"code":"Px00061010091","type":"CDM"},{"code":"75559","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.0,"discounted_cash":2305.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH W/WO DYE","code_information":[{"code":"Px00061010092","type":"CDM"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":4115.0,"discounted_cash":2880.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC W/STRESS IMG & DYE","code_information":[{"code":"Px00061010093","type":"CDM"},{"code":"75563","type":"HCPCS"}],"standard_charges":[{"gross_charge":4115.0,"discounted_cash":2880.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC VELOC FLOW MAPPING","code_information":[{"code":"Px00061010094","type":"CDM"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI GUIDANCE NEEDLE PLACEMENT RS&I","code_information":[{"code":"Px00061010096","type":"CDM"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":4733.0,"discounted_cash":3313.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BONE MARROW BLOOD SUPPLY","code_information":[{"code":"Px00061010100","type":"CDM"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3720.0,"discounted_cash":2604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010114","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010115","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3279.0,"discounted_cash":2295.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010116","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5398.0,"discounted_cash":3778.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA SPINAL CANAL W/WO CONTRAST","code_information":[{"code":"Px00061010120","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":4690.0,"discounted_cash":3283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA W/O CONTRAST SPINAL CANAL","code_information":[{"code":"Px00061010121","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":3327.0,"discounted_cash":2328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA W/O AND W/CONT SPINAL CANAL","code_information":[{"code":"Px00061010122","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":4690.0,"discounted_cash":3283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA W/CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010123","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4690.0,"discounted_cash":3283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA W/O CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010124","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3327.0,"discounted_cash":2328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA W/O AND W/CONT UPPER EXTREMITY","code_information":[{"code":"Px00061010125","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":4690.0,"discounted_cash":3283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI PROCEDURE UNLISTED","code_information":[{"code":"Px00061010139","type":"CDM"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":2046.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1641.0,"discounted_cash":1148.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010144","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010145","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/O DYE","code_information":[{"code":"Px00061010148","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3892.0,"discounted_cash":2724.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY W/O DYE LIMITED","code_information":[{"code":"Px00061010150","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI JOINT UPR EXTREM W/O DYE LIMITED","code_information":[{"code":"Px00061010184","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY W/O DYE LIMITED","code_information":[{"code":"Px00061010218","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI JNT OF LWR EXTRE W/O DYE LIMITED","code_information":[{"code":"Px00061010222","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W & W/O DYE","code_information":[{"code":"Px00061010237","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":6060.0,"discounted_cash":4242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/DYE","code_information":[{"code":"Px00061010238","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":2437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3279.0,"discounted_cash":2295.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST UNILATERAL","code_information":[{"code":"Px00061010279","type":"CDM"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":1344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST BILATERAL","code_information":[{"code":"Px00061010280","type":"CDM"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1922.0,"discounted_cash":1345.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL","code_information":[{"code":"Px00061010281","type":"CDM"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":3020.0,"discounted_cash":2114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BREAST W/O & W/ CONTRAST W/ CAD BIL","code_information":[{"code":"Px00061010282","type":"CDM"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":6041.0,"discounted_cash":4228.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2026.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O DYE LIMITED","code_information":[{"code":"Px00061110002","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2026.0,"discounted_cash":1418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2535.0,"discounted_cash":1774.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE LIMITED","code_information":[{"code":"Px00061110008","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2535.0,"discounted_cash":1774.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE W/FIDUCIAL MRKRS","code_information":[{"code":"Px00061110010","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1985.0,"discounted_cash":1389.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE W/O FIDUCIAL MRKRS","code_information":[{"code":"Px00061110011","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1249.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3226.0,"discounted_cash":2258.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2476.0,"discounted_cash":1733.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210002","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2476.0,"discounted_cash":1733.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3100.0,"discounted_cash":2170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210004","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":1779.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4216.0,"discounted_cash":2951.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3574.0,"discounted_cash":2501.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":4361.0,"discounted_cash":3052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210008","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3865.0,"discounted_cash":2705.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4201.0,"discounted_cash":2940.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210010","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":3865.0,"discounted_cash":2705.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4361.0,"discounted_cash":3052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE LIMITED","code_information":[{"code":"Px00061210012","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4361.0,"discounted_cash":3052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4761.0,"discounted_cash":3332.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE LIMITED","code_information":[{"code":"Px00061210014","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":3100.0,"discounted_cash":2170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6695.0,"discounted_cash":4686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O & W/DYE LIMITED","code_information":[{"code":"Px00061210016","type":"CDM"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":4361.0,"discounted_cash":3052.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6695.0,"discounted_cash":4686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MRA PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061210028","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":4476.0,"discounted_cash":3133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/DYE","code_information":[{"code":"Px00061810001","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.0,"discounted_cash":3111.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit 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":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit 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":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit 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":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit 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":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit 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":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION MIN WITH CRITICAL CARE G0390 CDM","code_information":[{"code":"Px00068110000","type":"CDM"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":8855.0,"discounted_cash":6198.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4715.0,"discounted_cash":3300.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210002","type":"CDM"}],"standard_charges":[{"gross_charge":4210.0,"discounted_cash":2947.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210104","type":"CDM"}],"standard_charges":[{"gross_charge":5219.0,"discounted_cash":3653.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5847.0,"discounted_cash":4092.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAG DEL RECOV PER HR CLASS 1","code_information":[{"code":"Px00072010027","type":"CDM"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAG DEL RECOV PER HR CLASS 2","code_information":[{"code":"Px00072010030","type":"CDM"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":1048.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAG DEL RECOV PER HR CLASS 3","code_information":[{"code":"Px00072010033","type":"CDM"}],"standard_charges":[{"gross_charge":1932.0,"discounted_cash":1352.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAG DEL RECOV PER HR CLASS 4","code_information":[{"code":"Px00072010036","type":"CDM"}],"standard_charges":[{"gross_charge":2369.0,"discounted_cash":1658.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ANTE ACUITY PER HR CLASS 1","code_information":[{"code":"Px00072010067","type":"CDM"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 1 CDM","code_information":[{"code":"Px00072210001","type":"CDM"}],"standard_charges":[{"gross_charge":15608.0,"discounted_cash":10925.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 2 CDM","code_information":[{"code":"Px00072210002","type":"CDM"}],"standard_charges":[{"gross_charge":17152.0,"discounted_cash":12006.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 3 CDM","code_information":[{"code":"Px00072210003","type":"CDM"}],"standard_charges":[{"gross_charge":18697.0,"discounted_cash":13087.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VAGINAL DELIVERY LEVEL 4 CDM","code_information":[{"code":"Px00072210004","type":"CDM"}],"standard_charges":[{"gross_charge":20167.0,"discounted_cash":14116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CIRCUMCISION W/REGIONL BLOCK CDM","code_information":[{"code":"Px00072310001","type":"CDM"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERTION CERVICAL DILATOR SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00072410001","type":"CDM"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD W/INTERP & REPORT","code_information":[{"code":"Px00073010001","type":"CDM"},{"code":"93000","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RHYTHM ECG TRACING ONLY","code_information":[{"code":"Px00073010003","type":"CDM"},{"code":"93041","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":334.0,"discounted_cash":233.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOLTER MONITOR ANALYSIS & REPT","code_information":[{"code":"Px00073110002","type":"CDM"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIAC EVENT MONITOR SET UP","code_information":[{"code":"Px00073210001","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTIGRAPHY TESTING","code_information":[{"code":"Px00074010001","type":"CDM"},{"code":"95803","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"Px00074010002","type":"CDM"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2600.0,"discounted_cash":1820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MAINTENANCE WAKEFULNESS TEST","code_information":[{"code":"Px00074010003","type":"CDM"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":3853.0,"discounted_cash":2697.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLEEP STUDY UNATT&RESP EFFT","code_information":[{"code":"Px00074010004","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLEEP SCORING","code_information":[{"code":"Px00074010005","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PORTABLE SLEEP SCREENING IP","code_information":[{"code":"Px00074010006","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC AUTOSET TITRATION","code_information":[{"code":"Px00074010007","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY 4 OR MORE","code_information":[{"code":"Px00074010009","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4871.0,"discounted_cash":3409.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAM REDUCED SERVICE","code_information":[{"code":"Px00074010010","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2436.0,"discounted_cash":1705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP","code_information":[{"code":"Px00074010011","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":5318.0,"discounted_cash":3722.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP REDUCED","code_information":[{"code":"Px00074010012","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":3940.0,"discounted_cash":2758.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG EXTENDED MONITORING 41-60 MINUTES","code_information":[{"code":"Px00074010013","type":"CDM"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":1556.0,"discounted_cash":1089.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1663.0,"discounted_cash":1164.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY","code_information":[{"code":"Px00074010015","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND ASLEEP","code_information":[{"code":"Px00074010018","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG COMA OR SLEEP ONLY","code_information":[{"code":"Px00074010020","type":"CDM"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":1012.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG CEREBRAL DEATH ONLY","code_information":[{"code":"Px00074010022","type":"CDM"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG AWAKE AND DROWSY PORTABLE","code_information":[{"code":"Px00074010035","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG PEDIATRIC/NEONATAL AWAKE & ASLEEP","code_information":[{"code":"Px00074010038","type":"CDM"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":1021.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC EEG- SSEP UPPERS & LOWERS","code_information":[{"code":"Px00074010044","type":"CDM"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1135.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1203.0,"discounted_cash":842.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2937.0,"discounted_cash":2055.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":957.0,"discounted_cash":669.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5443.0,"discounted_cash":3810.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAM 1 ON 1 PT","code_information":[{"code":"Px00074010127","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4871.0,"discounted_cash":3409.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOM LT/6 YRS SLEEP STAGE GTE/4 ADDL PARAM ATTND","code_information":[{"code":"Px00074010128","type":"CDM"},{"code":"95782","type":"HCPCS"}],"standard_charges":[{"gross_charge":4451.0,"discounted_cash":3115.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOM LT/6 YRS SLEEP W/CPAP/BILVL VENT GTE/4 PARAM","code_information":[{"code":"Px00074010129","type":"CDM"},{"code":"95783","type":"HCPCS"}],"standard_charges":[{"gross_charge":4860.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":16036.0,"discounted_cash":11225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":5287.0,"discounted_cash":3700.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":4555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":9951.0,"discounted_cash":6965.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":12527.0,"discounted_cash":8768.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":13578.0,"discounted_cash":9504.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":338.0,"discounted_cash":236.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SMPL REPAIR FC/ERS/EYLD/NS/LPS/MUC 5.1CM-7.5 CM CDM","code_information":[{"code":"Px00076100177","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110002","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":236.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110003","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110004","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110005","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":547.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IV ADMIN INFUS PROLONG VIA PUMP IMPLANTABLE OR PT OWN EXTER > 8HRS CDM","code_information":[{"code":"Px00076110310","type":"CDM"},{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":880.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INS MARK THOR FOR RT PERQ","code_information":[{"code":"Px00076110319","type":"CDM"},{"code":"32553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.0,"discounted_cash":712.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE","code_information":[{"code":"Px00076110458","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV","code_information":[{"code":"Px00076110494","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC OP TREATMENT ROOM","code_information":[{"code":"Px00076110518","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POST PARTUM VISIT","code_information":[{"code":"Px00076110530","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP","code_information":[{"code":"Px00076110564","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":100.0,"discounted_cash":70.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC PR ADMIN VACCINE INITIAL CDM","code_information":[{"code":"Px00077110225","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 90472 ADMIN VACCINE EA ADDL CDM","code_information":[{"code":"Px00077110226","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMODIALYSIS IP","code_information":[{"code":"Px00080110006","type":"CDM"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":1369.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD IP","code_information":[{"code":"Px00080310002","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1957.0,"discounted_cash":1369.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC HEMODIAL OP ER/POSTOP ESRD","code_information":[{"code":"Px00082910001","type":"CDM"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":1191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CAPD OP","code_information":[{"code":"Px00084110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIALYSIS CRRT OP","code_information":[{"code":"Px00088110001","type":"CDM"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC POLYSOMNOGRAPHY 1-3","code_information":[{"code":"Px00092010001","type":"CDM"},{"code":"95808","type":"HCPCS"}],"standard_charges":[{"gross_charge":2284.0,"discounted_cash":1598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT CDM","code_information":[{"code":"Px00092010008","type":"CDM"},{"code":"95250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1157.0,"discounted_cash":809.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC RAPID DESENSITIZATION PROCEDURE EACH HOUR CDM","code_information":[{"code":"Px00092010023","type":"CDM"},{"code":"95180","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL NON-STRESS TEST CDM","code_information":[{"code":"Px00092010032","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":700.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC FETAL CONTRACT STRESS TEST","code_information":[{"code":"Px00092010033","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT  CDM","code_information":[{"code":"Px00092010074","type":"CDM"},{"code":"95249","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SLP STDY UNATTENDED","code_information":[{"code":"Px00092010106","type":"CDM"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1999.0,"discounted_cash":1399.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1427.0,"discounted_cash":998.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY","code_information":[{"code":"Px00092110003","type":"CDM"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1328.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":949.0,"discounted_cash":664.3,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS","code_information":[{"code":"Px00092110008","type":"CDM"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1294.0,"discounted_cash":905.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2408.0,"discounted_cash":1685.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1535.0,"discounted_cash":1074.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":1611.0,"discounted_cash":1127.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1026.0,"discounted_cash":718.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2554.0,"discounted_cash":1787.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1702.0,"discounted_cash":1191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1085.0,"discounted_cash":759.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2663.0,"discounted_cash":1864.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1698.0,"discounted_cash":1188.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1246.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1135.0,"discounted_cash":794.5,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":5936.0,"discounted_cash":4155.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":3787.0,"discounted_cash":2650.9,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":3655.0,"discounted_cash":2558.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3166.0,"discounted_cash":2216.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":2018.0,"discounted_cash":1412.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"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":2148.0,"discounted_cash":1503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"},{"gross_charge":1371.0,"discounted_cash":959.7,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM OUTPATIENT"}]},{"description":"HC DUPLEX SCAN HEMODIALYSIS ACCESS","code_information":[{"code":"Px00092110024","type":"CDM"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":557.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":439.0,"discounted_cash":307.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210001","type":"CDM"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS CDM","code_information":[{"code":"Px00092210003","type":"CDM"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI CDM","code_information":[{"code":"Px00092210009","type":"CDM"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING UPPER LIMBS","code_information":[{"code":"Px00092210013","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING LOWER LIMBS","code_information":[{"code":"Px00092210018","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1801.0,"discounted_cash":1260.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING LOWER LIMBS EXTENDED","code_information":[{"code":"Px00092210019","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":2523.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VISUAL EVOKED POTENTIAL TEST","code_information":[{"code":"Px00092210020","type":"CDM"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":685.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC VISUAL EVOKED POTENTIAL TEST EXTENDED","code_information":[{"code":"Px00092210021","type":"CDM"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":879.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SOMATOSENSORY TESTING UPPER LIMBS EXTENDED","code_information":[{"code":"Px00092210024","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":3079.0,"discounted_cash":2155.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING 3-10 MIN","code_information":[{"code":"Px00094010003","type":"CDM"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING > 10 MIN","code_information":[{"code":"Px00094010004","type":"CDM"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION","code_information":[{"code":"Px00094010006","type":"CDM"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSERT STRAIGHT CATH BLADDER","code_information":[{"code":"Px00094010050","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","code_information":[{"code":"Px00094010051","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC ACTINOTHERAPY ULTRAVIOLET LIGHT","code_information":[{"code":"Px00094010052","type":"CDM"},{"code":"96900","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC THERAPUTIC PHLEBOTOMY","code_information":[{"code":"Px00094010204","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ BARIATRIC THERAPY INDIV EACH 15MIN","code_information":[{"code":"Px00094210006","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ BARIATIC EA 15 MIN","code_information":[{"code":"Px00094210009","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC SELF-MGMT EDUC & TRAIN 1 PT CDM","code_information":[{"code":"Px00094210051","type":"CDM"},{"code":"98960","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 30 MIN","code_information":[{"code":"Px00094210105","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 60 MIN","code_information":[{"code":"Px00094210106","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC LACTATION CONSULT 90 MIN","code_information":[{"code":"Px00094210303","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":422.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC DIABETES PREV STANDARD CURR","code_information":[{"code":"Px00094210322","type":"CDM"},{"code":"0403T","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC CARDIAC REHAB/MONITOR PHASE 2","code_information":[{"code":"Px00094310023","type":"CDM"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800001","type":"CDM"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800002","type":"CDM"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM","code_information":[{"code":"Px00096310238","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 40810 EXCISION OF MOUTH LESION","code_information":[{"code":"Px00096910210","type":"CDM"},{"code":"40810","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 51705 CHANGE CYSTOSTOMY TUBE SIMPLE","code_information":[{"code":"Px00096910238","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 76815 US OB LIMITED FETUS(S)","code_information":[{"code":"Px00096910319","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11421 EXC H-F-NK-SP B9+MARG 0.6-1","code_information":[{"code":"Px00096910489","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 17110 DESTRUCT B9 LESION 1-14","code_information":[{"code":"Px00096910506","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 25520 CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT","code_information":[{"code":"Px00096910714","type":"CDM"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 54450 PREPUTIAL STRETCHING","code_information":[{"code":"Px00096910817","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 20606 DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US","code_information":[{"code":"Px00096911041","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":88.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 20611 DRAIN/INJ JOINT/BURSA MAJOR W/US","code_information":[{"code":"Px00096911042","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 22510 PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00096911047","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 22511 PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00096911048","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.0,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 22512 VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00096911049","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":354.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 46601 DIAGNOSTIC ANOSCOPY","code_information":[{"code":"Px00096911109","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11010 DEBRIDE SKIN AT FX SITE","code_information":[{"code":"Px00097510032","type":"CDM"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11012 DEB SKIN BONE AT FX SITE","code_information":[{"code":"Px00097510036","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11200 REMOVAL OF SKIN TAGS","code_information":[{"code":"Px00097510044","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG","code_information":[{"code":"Px00097510046","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11308 SHAVE SKIN LESION OVER 2.0 CM SCLP NK HND FT GEN","code_information":[{"code":"Px00097510058","type":"CDM"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/OR LESS","code_information":[{"code":"Px00097510074","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 35206 REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY CDM","code_information":[{"code":"Px00097510198","type":"CDM"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2071.0,"discounted_cash":1449.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 35207 REPAIR BLOOD VESSEL LESION, HAND/FINGER","code_information":[{"code":"Px00097510199","type":"CDM"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":1959.0,"discounted_cash":1371.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 42999 THROAT SURGERY PROCEDURE","code_information":[{"code":"Px00097510280","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 14020 SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS SCALP,ARM","code_information":[{"code":"Px00097510302","type":"CDM"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 19020 INCISION OF BREAST LESION","code_information":[{"code":"Px00097510353","type":"CDM"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 19330 REMOVAL OF IMPLANT MATERIAL","code_information":[{"code":"Px00097510376","type":"CDM"},{"code":"19330","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":522.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 20612 ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00097510383","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11043 DEBRIDEMENT MUSCLES/FASCIA FIRST 20 SQ CM OR LESS","code_information":[{"code":"Px00097510465","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":421.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 53000 INCISION OF URETHRA","code_information":[{"code":"Px00097510655","type":"CDM"},{"code":"53000","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 45900 REDUCTION OF RECTAL PROLAPSE","code_information":[{"code":"Px00097510780","type":"CDM"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":360.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 46999 ANUS SURGERY PROCEDURE","code_information":[{"code":"Px00097510808","type":"CDM"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 49900 SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN CDM","code_information":[{"code":"Px00097510889","type":"CDM"},{"code":"49900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.0,"discounted_cash":1483.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00097511282","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING","code_information":[{"code":"Px00097511405","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11005 DEBRIDE ABDOM WALL","code_information":[{"code":"Px00097511563","type":"CDM"},{"code":"11005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 17999 SKIN TISSUE PROCEDURE","code_information":[{"code":"Px00097511694","type":"CDM"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 20661 APPLICATION OF HEAD BRACE","code_information":[{"code":"Px00097511726","type":"CDM"},{"code":"20661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":895.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 99283 VISIT LOW MDM CDM","code_information":[{"code":"Px00098110009","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 99284 VISIT MODERATE MDM CDM","code_information":[{"code":"Px00098110012","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 99285 VISIT HIGH MDM CDM","code_information":[{"code":"Px00098110016","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":301.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 92511 NASPHARYNGOSCOPY CDM","code_information":[{"code":"Px00098110018","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00098110021","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 0131C SANE EXAM 15-45 MIN CDM","code_information":[{"code":"Px00098110025","type":"CDM"},{"code":"0131C","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11982 REMOVE DRUG IMPLANT DEVICE CDM","code_information":[{"code":"Px00098110052","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 92532 POSITIONAL NYSTAGMUS TEST CDM","code_information":[{"code":"Px00098110054","type":"CDM"},{"code":"92532","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36589 REMOVAL TUNNELED CV CATH CDM","code_information":[{"code":"Px00098110086","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":256.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 92953 TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00098110101","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM","code_information":[{"code":"Px00098110102","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 95992 CANALITH REPOSITIONING PROCEDURE CDM","code_information":[{"code":"Px00098110112","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 49451 REPLACE DUOD/JEJ TUBE PERC CDM","code_information":[{"code":"Px00098110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 76604 US EXAM CHEST CDM","code_information":[{"code":"Px00098110151","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 64405 NERVE BLOCK INJ OCCIPITAL CDM","code_information":[{"code":"Px00098110155","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36680 INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00098110226","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":476.0,"discounted_cash":333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":476.0,"discounted_cash":333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00098110234","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 10121 REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00098110235","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":506.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 10140 DRAINAGE OF HEMATOMA/FLUID CDM","code_information":[{"code":"Px00098110236","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":298.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":341.0,"discounted_cash":238.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 10180 COMPLEX DRAINAGE WOUND CDM","code_information":[{"code":"Px00098110239","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11000 DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00098110240","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":828.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11045 DEB SUBQ TISSUE ADD-ON CDM","code_information":[{"code":"Px00098110245","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":497.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11720 DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00098110250","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11730 REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00098110251","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11750 REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00098110254","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 11760 REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00098110256","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":600.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":561.0,"discounted_cash":392.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":740.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":447.0,"discounted_cash":312.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1022.0,"discounted_cash":715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1113.0,"discounted_cash":779.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1224.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":757.0,"discounted_cash":529.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":946.0,"discounted_cash":662.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1058.0,"discounted_cash":740.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":679.0,"discounted_cash":475.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":772.0,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":911.0,"discounted_cash":637.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":971.0,"discounted_cash":679.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":393.0,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1042.0,"discounted_cash":729.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":918.0,"discounted_cash":642.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 1040M ACCIDENT REPORT CDM","code_information":[{"code":"Px00098110304","type":"CDM"},{"code":"1040M","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 30000 DRAINAGE OF NOSE LESION CDM","code_information":[{"code":"Px00098110314","type":"CDM"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 30300 REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00098110316","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 30901 CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00098110317","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 30903 CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00098110319","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 30905 CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00098110321","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31500 INS EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00098110324","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31505 DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00098110326","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31511 REMOVE FOREIGN BODY LARYNX CDM","code_information":[{"code":"Px00098110328","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31515 LARYNGOSCOPY FOR ASPIRATION CDM","code_information":[{"code":"Px00098110329","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31575 DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00098110333","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 31605 CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00098110336","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 32551 INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00098110342","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":758.0,"discounted_cash":530.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":885.0,"discounted_cash":619.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":754.0,"discounted_cash":527.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 41800 DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00098110360","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 42700 DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00098110366","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 42809 REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00098110368","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 46040 INCISION OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110381","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 46050 INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00098110382","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 46083 INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00098110383","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 46320 REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00098110386","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 46600 DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00098110387","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 51700 IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00098110395","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 51702 INSERT TEMP BLADDER CATHETER CDM","code_information":[{"code":"Px00098110396","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 51703 INSERT BLADDER CATHETER COMPLEX CDM","code_information":[{"code":"Px00098110397","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 55100 DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00098110399","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":837.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":966.0,"discounted_cash":676.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":886.0,"discounted_cash":620.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":981.0,"discounted_cash":686.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":947.0,"discounted_cash":662.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":586.0,"discounted_cash":410.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 28540 CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00098110452","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 28630 TREAT METATARSOPHAL DISLOCATION CDM","code_information":[{"code":"Px00098110460","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 28660 CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00098110462","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 28665 TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00098110464","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 29105 LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110468","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110469","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 29505 APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00098110479","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110480","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":336.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM","code_information":[{"code":"Px00098110489","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36620 INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00098110499","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1009.0,"discounted_cash":706.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1245.0,"discounted_cash":871.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":464.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1104.0,"discounted_cash":772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1252.0,"discounted_cash":876.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":481.0,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 20102 EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00098110519","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":459.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 20103 EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00098110520","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00098110523","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 20950 FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00098110532","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":476.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":757.0,"discounted_cash":529.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 21337 CLOSED TREATMENT NASAL SEPTAL FRACTURE CDM","code_information":[{"code":"Px00098110536","type":"CDM"},{"code":"21337","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":760.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1651.0,"discounted_cash":1155.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 21480 RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00098110541","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 21820 TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00098110544","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":862.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1288.0,"discounted_cash":901.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":828.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":989.0,"discounted_cash":692.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":388.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36600 WITHDRAWAL OF ARTERIAL BLOOD CDM","code_information":[{"code":"Px00098110587","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36400 VNPNXR/YOUNGER THAN 3YRS PHY/QHP SKILL FEM/JUGLAR VEIN CDM","code_information":[{"code":"Px00098110589","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 92950 CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00098110596","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 59409 VAGINAL DELIVERY CDM","code_information":[{"code":"Px00098110602","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1502.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 37195 THROMBOLYTIC THERAPY STROKE CDM","code_information":[{"code":"Px00098110608","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":267.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 37609 TEMPORAL ARTERY PROCEDURE CDM","code_information":[{"code":"Px00098110609","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":841.0,"discounted_cash":588.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1162.0,"discounted_cash":813.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 24650 TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00098110718","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":483.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1148.0,"discounted_cash":803.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 25530 TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00098110734","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":734.0,"discounted_cash":513.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1365.0,"discounted_cash":955.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":866.0,"discounted_cash":606.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1436.0,"discounted_cash":1005.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 25622 TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00098110746","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 25650 TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00098110754","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1002.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":705.0,"discounted_cash":493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1469.0,"discounted_cash":1028.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":955.0,"discounted_cash":668.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":701.0,"discounted_cash":490.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":805.0,"discounted_cash":563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1113.0,"discounted_cash":779.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":866.0,"discounted_cash":606.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":799.0,"discounted_cash":559.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":524.0,"discounted_cash":366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":843.0,"discounted_cash":590.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":728.0,"discounted_cash":509.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":863.0,"discounted_cash":604.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 56420 DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00098110803","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 57180 TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00098110806","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 58301 REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00098110808","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM","code_information":[{"code":"Px00098110812","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 62272 DRAIN CEREBRO SPINAL FLUID CDM","code_information":[{"code":"Px00098110813","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":377.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 64400 NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00098110814","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 64450 NERVE BLOCK OTHER PERIPHERAL CDM","code_information":[{"code":"Px00098110817","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 67700 DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00098110825","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":505.0,"discounted_cash":353.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 27200 TREAT TAIL BONE FRACTURE CDM","code_information":[{"code":"Px00098110839","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":964.0,"discounted_cash":674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1053.0,"discounted_cash":737.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1445.0,"discounted_cash":1011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 27502 CL TX OF FEMORAL SHAFT FX W/MANIP CDM","code_information":[{"code":"Px00098110869","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.0,"discounted_cash":1336.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 27510 CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00098110872","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":570.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":855.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1556.0,"discounted_cash":1089.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":960.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":1232.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":884.0,"discounted_cash":618.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":478.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 36593 DECLOT VASCULAR DEVICE CDM","code_information":[{"code":"Px00098110904","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR ED 1073M ACTIVITY PRESCRIPTION FORM INSURER REQ CDM","code_information":[{"code":"Px00098110914","type":"CDM"},{"code":"1073M","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"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":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 99202 NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310002","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 99205 NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310005","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 99211 ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00098310006","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 99215 ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310010","type":"CDM"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"Px00098310202","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11106 INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00098310204","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 11306 SHAVE SKIN LESION 0.6 TO 1.0 CM SCLP NK HND FT GEN","code_information":[{"code":"Px00098310347","type":"CDM"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 17250 CHEMICAL CAUTERY TISSUE","code_information":[{"code":"Px00098310353","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 59200 INSERT CERVICAL DILATOR","code_information":[{"code":"Px00098310447","type":"CDM"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"HC PR 28295 CORRECT HALLUX VALGUS SESAM","code_information":[{"code":"Px00098311240","type":"CDM"},{"code":"28295","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.0,"discounted_cash":524.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION (Unit Price)"}]},{"description":"NEOMYCIN 1% ENEMA","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000034","type":"CDM"},{"code":"00000000034","type":"NDC"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":16.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN LIQUID 50 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000000102","type":"CDM"},{"code":"00000000102","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM 125 MG IN 125 ML NS INFUSION ONE STEP","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"Rx00000000145","type":"CDM"},{"code":"00000000145","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE 400 MCG IN 100 ML NS INFUSION ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000153","type":"CDM"},{"code":"00000000153","type":"NDC"}],"standard_charges":[{"gross_charge":978.67,"discounted_cash":685.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.03% (0.3 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000000195","type":"CDM"},{"code":"J7315","type":"HCPCS"},{"code":"00000000195","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":65.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML,MORPHINE SULFATE-NACL INJ SOLN PREF SYR 2 MG/2ML-0.9%,MORPHINE SULFATE IV SOLN 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML,MORPHINE SULFATE-NACL INJ SOLN PREF SYR 2 MG/2ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"code":"00000000338","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE 1% 30 ML WITH EPINEPHRINE 1:1000 0.3 ML INJECTION ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000353","type":"CDM"},{"code":"00000000353","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN 0.4 MG/ML FOR TOPICAL APPLICATION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000356","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000000356","type":"NDC"}],"standard_charges":[{"gross_charge":160.38,"discounted_cash":112.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN LIQUID 10 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000357","type":"CDM"},{"code":"00000000357","type":"NDC"}],"standard_charges":[{"gross_charge":137.34,"discounted_cash":96.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN LIQUID 40 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000000385","type":"CDM"},{"code":"00000000385","type":"NDC"}],"standard_charges":[{"gross_charge":111.94,"discounted_cash":78.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LABETALOL 40 MG/ML ORAL SUSPENSION","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00000000392","type":"CDM"},{"code":"00000000392","type":"NDC"}],"standard_charges":[{"gross_charge":68.78,"discounted_cash":48.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE 5 MG IN 50 ML NS INFUSION ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000000548","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00000000548","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE 24 MCG/ML IN NS INTRAPROCEDURE","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000000735","type":"CDM"},{"code":"00000000735","type":"NDC"}],"standard_charges":[{"gross_charge":247.38,"discounted_cash":173.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE 6 MCG/ML IN NS INTRAPROCEDURE","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00000000736","type":"CDM"},{"code":"00000000736","type":"NDC"}],"standard_charges":[{"gross_charge":3230.1,"discounted_cash":2261.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"STUDY-NIVOLUMAB 10 MG/ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000000762","type":"CDM"},{"code":"J9999","type":"HCPCS"},{"code":"00000000762","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001042","type":"CDM"},{"code":"00000001042","type":"NDC"}],"standard_charges":[{"gross_charge":350.88,"discounted_cash":245.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE 250 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001148","type":"CDM"},{"code":"00000001148","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 4 TABLET"}]},{"description":"CEFAZOLIN 25 MG/ML OPHTHALMIC SOLUTION","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001177","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000001177","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00000001204","type":"CDM"},{"code":"00000001204","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001288","type":"CDM"},{"code":"00000001288","type":"NDC"}],"standard_charges":[{"gross_charge":85.1,"discounted_cash":59.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001472","type":"CDM"},{"code":"00000001472","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001473","type":"CDM"},{"code":"00000001473","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001474","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00000001474","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001475","type":"CDM"},{"code":"00000001475","type":"NDC"}],"standard_charges":[{"gross_charge":210.53,"discounted_cash":147.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMSIROLIMUS 10 MG/ML (FINAL CONCENTRATION) IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000001484","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"00000001484","type":"NDC"}],"standard_charges":[{"gross_charge":12183.95,"discounted_cash":8528.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CABAZITAXEL INJ 10 MG/ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx00000001485","type":"CDM"},{"code":"J9043","type":"HCPCS"},{"code":"00000001485","type":"NDC"}],"standard_charges":[{"gross_charge":62529.1,"discounted_cash":43770.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001567","type":"CDM"},{"code":"00000001567","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000001587","type":"CDM"},{"code":"00000001587","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM 1 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000001590","type":"CDM"},{"code":"00000001590","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001596","type":"CDM"},{"code":"00000001596","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 4 TABLET"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML (ED HOMEPACK) PO SYRP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000001602","type":"CDM"},{"code":"00000001602","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL 50 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000001605","type":"CDM"},{"code":"00000001605","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TECHNETIUM TC-99M OXIDRONATE (HDP)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001725","type":"CDM"},{"code":"A9561","type":"HCPCS"},{"code":"00000001725","type":"NDC"}],"standard_charges":[{"gross_charge":190.68,"discounted_cash":133.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"Y-90 SIRSPHERES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001729","type":"CDM"},{"code":"C2616","type":"HCPCS"},{"code":"00000001729","type":"NDC"}],"standard_charges":[{"gross_charge":73380.0,"discounted_cash":51366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"Y-90 THERASPHERES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001730","type":"CDM"},{"code":"C2616","type":"HCPCS"},{"code":"00000001730","type":"NDC"}],"standard_charges":[{"gross_charge":64000.0,"discounted_cash":44800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL-SODIUM BICARB LOCAL SOLN PREF SYR 0.9-8.4%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000001747","type":"CDM"},{"code":"00000001747","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE 4 MCG/ML BOLUS ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001859","type":"CDM"},{"code":"00000001859","type":"NDC"}],"standard_charges":[{"gross_charge":117.62,"discounted_cash":82.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPYRIDAMOLE IN NS 60MG/40ML INJ (SIMPLE)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00000001860","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00000001860","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.05% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001871","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001871","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL-NACL INJ SOLN PREF SYR 0.0625-0.9% (50 ML)","drug_information":{"unit":5.6,"type":"ML"},"code_information":[{"code":"Rx00000001872","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001872","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.075% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001873","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001873","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.1% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001874","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001874","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.125% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.2,"type":"ML"},"code_information":[{"code":"Rx00000001875","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001875","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID 1 G IN 50 ML NS IVPB ONE STEP","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000002165","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000002165","type":"NDC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002196","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00000002196","type":"NDC"}],"standard_charges":[{"gross_charge":33.52,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOFENAC SODIUM OPHTH SOLN 0.1%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000002275","type":"CDM"},{"code":"00000002275","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL 0.2 MG/ML IN SALINE SYRINGE INTRAPROCEDURE","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000002281","type":"CDM"},{"code":"00000002281","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002310","type":"CDM"},{"code":"00000002310","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000002334","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00000002334","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOCYANINE GREEN?25 MG/ 1 ML IN STERILE WATER INJECTION SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000002358","type":"CDM"},{"code":"00000002358","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BSS 2.25ML + LIDOCAINE PF 2% 0.75ML + EPINEPHRINE (1:1000) 1ML ONE STEP","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000002465","type":"CDM"},{"code":"00000002465","type":"NDC"}],"standard_charges":[{"gross_charge":81.21,"discounted_cash":56.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00000002505","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000002505","type":"NDC"}],"standard_charges":[{"gross_charge":221.88,"discounted_cash":155.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLECAINIDE 20 MG/ML SUSPENSION","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000002624","type":"CDM"},{"code":"00000002624","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOXIFLOXACIN 0.5 % INTRACAMERAL INJECTION","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000002644","type":"CDM"},{"code":"00000002644","type":"NDC"}],"standard_charges":[{"gross_charge":253.97,"discounted_cash":177.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL 4 MG/0.1ML (HOMEPACK) INTRANASAL LIQD","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000002689","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00000002689","type":"NDC"}],"standard_charges":[{"gross_charge":512.97,"discounted_cash":359.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000002862","type":"CDM"},{"code":"00000002862","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROTAGLIDE INJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000002916","type":"CDM"},{"code":"00000002916","type":"NDC"}],"standard_charges":[{"gross_charge":944.83,"discounted_cash":661.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAPTOPRIL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003007","type":"CDM"},{"code":"00000003007","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 TABLET"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003023","type":"CDM"},{"code":"00000003023","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 TABLET"}]},{"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":17.19,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIMODIPINE 30 MG/ML (CONCENTRATE) PO LIQUID","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000003220","type":"CDM"},{"code":"00000003220","type":"NDC"}],"standard_charges":[{"gross_charge":89.74,"discounted_cash":62.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE 900 MG IN 500 ML D5W INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003249","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000003249","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE 150 MG IN 100 ML D5W IVPB ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003251","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000003251","type":"NDC"}],"standard_charges":[{"gross_charge":767.8,"discounted_cash":537.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003298","type":"CDM"},{"code":"00000003298","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN 50000 UNITS, CEFAZOLIN 1 GRAM, GENTAMICIN 80 MG IN NS 1000 ML ONESTEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003355","type":"CDM"},{"code":"00000003355","type":"NDC"}],"standard_charges":[{"gross_charge":71.69,"discounted_cash":50.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN 50,000 UNITS IN 10 ML NS - ONE STEP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003372","type":"CDM"},{"code":"00000003372","type":"NDC"}],"standard_charges":[{"gross_charge":73.66,"discounted_cash":51.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPINEPHRINE 8 MG IN 500 ML NS INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003506","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00000003506","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE 100 MG IN 500 ML D5W INFUSION ONE STEP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000003514","type":"CDM"},{"code":"00000003514","type":"NDC"}],"standard_charges":[{"gross_charge":503.91,"discounted_cash":352.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAPTOPRIL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003521","type":"CDM"},{"code":"00000003521","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 TABLET"}]},{"description":"OXYCODONE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003523","type":"CDM"},{"code":"00000003523","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 TABLET"}]},{"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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BSS 2.25ML + LIDOCAINE 4% 0.75ML + EPINEPHRINE (1:1000) 1ML ONE STEP","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00000003632","type":"CDM"},{"code":"00000003632","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003827","type":"CDM"},{"code":"00000003827","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000003829","type":"CDM"},{"code":"00000003829","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003908","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00000003908","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003919","type":"CDM"},{"code":"00000003919","type":"NDC"}],"standard_charges":[{"gross_charge":219.11,"discounted_cash":153.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 14 CAPSULE"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003928","type":"CDM"},{"code":"00000003928","type":"NDC"}],"standard_charges":[{"gross_charge":100.1,"discounted_cash":70.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 14 TABLET"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003946","type":"CDM"},{"code":"00000003946","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":13.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 TABLET"}]},{"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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1326.96,"discounted_cash":928.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":87.7,"discounted_cash":61.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":319.2,"discounted_cash":223.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":88.13,"discounted_cash":61.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":129.79,"discounted_cash":90.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":317.07,"discounted_cash":221.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":129.79,"discounted_cash":90.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004027","type":"CDM"},{"code":"00000004027","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52.62,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.1,"discounted_cash":59.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.03,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN 0.2% RECTAL OINTMENT","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00000004185","type":"CDM"},{"code":"00000004185","type":"NDC"}],"standard_charges":[{"gross_charge":205.06,"discounted_cash":143.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.02% (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004350","type":"CDM"},{"code":"00000004350","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":65.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.25% 30 ML + LIDOCAINE 1%-EPINEPHRINE 1:100,000 30 ML - ONE STEP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004439","type":"CDM"},{"code":"00000004439","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE 25 MG (ED HOMEPACK) RECTAL SUPP","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000004525","type":"CDM"},{"code":"00000004525","type":"NDC"}],"standard_charges":[{"gross_charge":127.37,"discounted_cash":89.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000004536","type":"CDM"},{"code":"00000004536","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG PREPACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004537","type":"CDM"},{"code":"00000004537","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED HOMEPACK) INHAL AERS","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00000004540","type":"CDM"},{"code":"00000004540","type":"NDC"}],"standard_charges":[{"gross_charge":173.94,"discounted_cash":121.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000004546","type":"CDM"},{"code":"00000004546","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG (ED HOMEPACK) TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004559","type":"CDM"},{"code":"00000004559","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 4 TABLET"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":8.0,"type":"EA"},"code_information":[{"code":"Rx00000004615","type":"CDM"},{"code":"00000004615","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004726","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00000004726","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN 250 MG (ED HOMEPACK) PO CAPS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004731","type":"CDM"},{"code":"00000004731","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN INTRAOCULAR SOLN PREF SYRINGE 0.04% (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004744","type":"CDM"},{"code":"00000004744","type":"NDC"}],"standard_charges":[{"gross_charge":94.05,"discounted_cash":65.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN 250 MG (ED HOMEPACK) PO CAPS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004792","type":"CDM"},{"code":"00000004792","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004796","type":"CDM"},{"code":"00000004796","type":"NDC"}],"standard_charges":[{"gross_charge":63.3,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG PREPACK","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004799","type":"CDM"},{"code":"00000004799","type":"NDC"}],"standard_charges":[{"gross_charge":91.61,"discounted_cash":64.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004816","type":"CDM"},{"code":"00000004816","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE 0.2% WITH EPINEPHRINE 1:200,000 ONE STEP","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004827","type":"CDM"},{"code":"00000004827","type":"NDC"}],"standard_charges":[{"gross_charge":96.29,"discounted_cash":67.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML (HOMEPACK) PO SUSR","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004836","type":"CDM"},{"code":"00000004836","type":"NDC"}],"standard_charges":[{"gross_charge":66.43,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML (30 ML PREPACK)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004840","type":"CDM"},{"code":"00000004840","type":"NDC"}],"standard_charges":[{"gross_charge":102.69,"discounted_cash":71.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL 5 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004841","type":"CDM"},{"code":"00000004841","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG (ED HOMEPACK) TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004916","type":"CDM"},{"code":"00000004916","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000004922","type":"CDM"},{"code":"00000004922","type":"NDC"}],"standard_charges":[{"gross_charge":148.63,"discounted_cash":104.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000004923","type":"CDM"},{"code":"00000004923","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":8.0,"type":"EA"},"code_information":[{"code":"Rx00000004924","type":"CDM"},{"code":"00000004924","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004925","type":"CDM"},{"code":"00000004925","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000004926","type":"CDM"},{"code":"00000004926","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004928","type":"CDM"},{"code":"00000004928","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML (ED HOMEPACK) PO SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000004929","type":"CDM"},{"code":"00000004929","type":"NDC"}],"standard_charges":[{"gross_charge":70.26,"discounted_cash":49.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MECLIZINE HCL 25 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":3.0,"type":"EA"},"code_information":[{"code":"Rx00000004932","type":"CDM"},{"code":"00000004932","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL 750 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004933","type":"CDM"},{"code":"00000004933","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROFURANTOIN MONOHYD MACRO 100 MG (ED HOMEPACK) PO CAPS","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000004935","type":"CDM"},{"code":"00000004935","type":"NDC"}],"standard_charges":[{"gross_charge":42.72,"discounted_cash":29.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":2.0,"type":"EA"},"code_information":[{"code":"Rx00000004937","type":"CDM"},{"code":"00000004937","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL 25 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004938","type":"CDM"},{"code":"00000004938","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE-PHENYLEPHRINE 4-1% EX SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004961","type":"CDM"},{"code":"00000004961","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE 0.0625 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004966","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000004966","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE 0.25 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004967","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000004967","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE 1 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004968","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000004968","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE 4 MG/ML INHALATION SOLUTION","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000004969","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000004969","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE 16 MG/ML INHALATION SOLUTION","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004970","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"00000004970","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL 10 MG (ED HOMEPACK) PO CAPS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004973","type":"CDM"},{"code":"00000004973","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004974","type":"CDM"},{"code":"00000004974","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE 20 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000004975","type":"CDM"},{"code":"00000004975","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL 25 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000004977","type":"CDM"},{"code":"00000004977","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% (ED HOMEPACK) IN NEBU","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx00000004996","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00000004996","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN 100 MG/5ML (ED HOMEPACK) PO LIQ","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000005032","type":"CDM"},{"code":"00000005032","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN 30,000 UNITS IN 3000 ML 0.9% NORMAL SALINE - ONE STEP","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00000005036","type":"CDM"},{"code":"00000005036","type":"NDC"}],"standard_charges":[{"gross_charge":287.28,"discounted_cash":201.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG PREPACK","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000005042","type":"CDM"},{"code":"00000005042","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.25%-EPI 1:200K 50ML, MS (PF) 4 MG, KETOROLAC 30 MG, KETAMINE 30 MG-ONE STEP","drug_information":{"unit":52.0,"type":"ML"},"code_information":[{"code":"Rx00000005053","type":"CDM"},{"code":"00000005053","type":"NDC"}],"standard_charges":[{"gross_charge":383.97,"discounted_cash":268.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML,INSULIN LISPRO SOLN CARTRIDGE 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"Rx00000005068","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00000005068","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000005080","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000005080","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML (HOMEPACK) PO SUSR","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005083","type":"CDM"},{"code":"00000005083","type":"NDC"}],"standard_charges":[{"gross_charge":427.77,"discounted_cash":299.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000005124","type":"CDM"},{"code":"00000005124","type":"NDC"}],"standard_charges":[{"gross_charge":64.24,"discounted_cash":44.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG & RALTEGRAVIR 400 MG (ED HOMEPACK) PO TABS KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005125","type":"CDM"},{"code":"00000005125","type":"NDC"}],"standard_charges":[{"gross_charge":1539.4,"discounted_cash":1077.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | NDC EA = 1 KIT"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000005126","type":"CDM"},{"code":"00000005126","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML (ED HOMEPACK) PO SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000005138","type":"CDM"},{"code":"00000005138","type":"NDC"}],"standard_charges":[{"gross_charge":70.26,"discounted_cash":49.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE 2 MG/ML INFUSION,CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005401","type":"CDM"},{"code":"00000005401","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00000005455","type":"CDM"},{"code":"00000005455","type":"NDC"}],"standard_charges":[{"gross_charge":234.08,"discounted_cash":163.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE 0.5 MEQ/ML ORAL LIQUID","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005758","type":"CDM"},{"code":"00000005758","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000006406","type":"CDM"},{"code":"00000006406","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000006739","type":"CDM"},{"code":"00000006739","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000006740","type":"CDM"},{"code":"00000006740","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000006776","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006776","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000006776","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006776","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000006777","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006777","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000006793","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006793","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000006793","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006793","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000006797","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006797","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006797","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000006797","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006815","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00000006815","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000006816","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00000006816","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000006817","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00000006817","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.06,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":27.99,"discounted_cash":19.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.06,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.57,"discounted_cash":13.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":26.16,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.14,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN 400 MG/5ML (ED PREPACK) PO SUSR","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006888","type":"CDM"},{"code":"00000006888","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000007103","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00000007103","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE SUSP 1 GM/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000007332","type":"CDM"},{"code":"00000007332","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE IN SIMPLE SYRUP 1 MG/ML PO SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000007447","type":"CDM"},{"code":"00000007447","type":"NDC"}],"standard_charges":[{"gross_charge":66.66,"discounted_cash":46.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000007525","type":"CDM"},{"code":"00000007525","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000007810","type":"CDM"},{"code":"00000007810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000007811","type":"CDM"},{"code":"00000007811","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000007812","type":"CDM"},{"code":"00000007812","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000007813","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00000007813","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000007814","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00000007814","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000007819","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00000007819","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000007820","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00000007820","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000007821","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00000007821","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00000007827","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00000007827","type":"NDC"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007858","type":"CDM"},{"code":"00000007858","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":60.0,"type":"EA"},"code_information":[{"code":"Rx00000007859","type":"CDM"},{"code":"00000007859","type":"NDC"}],"standard_charges":[{"gross_charge":6802.77,"discounted_cash":4761.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN W/ BENOXINATE OPHTH SOLN 0.25-0.4%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000026076","type":"CDM"},{"code":"00000026076","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002021301","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002021301","type":"NDC"}],"standard_charges":[{"gross_charge":44.75,"discounted_cash":31.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRIKIZUMAB-MRKZ IV SOLN 300 MG/15ML (20 MG/ML)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00002757501","type":"CDM"},{"code":"J2267","type":"HCPCS"},{"code":"00002757501","type":"NDC"}],"standard_charges":[{"gross_charge":41903.64,"discounted_cash":29332.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22983.58,"discounted_cash":16088.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6657.86,"discounted_cash":4660.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RAMUCIRUMAB IV SOLN 100 MG/10ML (FOR INFUSION)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002766901","type":"CDM"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":11139.94,"discounted_cash":7797.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RAMUCIRUMAB IV SOLN 500 MG/50ML (FOR INFUSION)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00002767801","type":"CDM"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":46291.68,"discounted_cash":32404.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NECITUMUMAB IV SOLN 800 MG/50ML (16 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00002771601","type":"CDM"},{"code":"J9295","type":"HCPCS"},{"code":"00002771601","type":"NDC"}],"standard_charges":[{"gross_charge":26710.22,"discounted_cash":18697.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002821501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":227.45,"discounted_cash":159.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002822201","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002822201","type":"NDC"}],"standard_charges":[{"gross_charge":507.34,"discounted_cash":355.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002822259","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002822259","type":"NDC"}],"standard_charges":[{"gross_charge":151.92,"discounted_cash":106.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879901","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879901","type":"NDC"}],"standard_charges":[{"gross_charge":141.12,"discounted_cash":98.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879959","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879959","type":"NDC"}],"standard_charges":[{"gross_charge":151.92,"discounted_cash":106.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) SUSP PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002880501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002880501","type":"NDC"}],"standard_charges":[{"gross_charge":105.56,"discounted_cash":73.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) SUSP PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002880559","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002880559","type":"NDC"}],"standard_charges":[{"gross_charge":104.41,"discounted_cash":73.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 500 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002882401","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002882401","type":"NDC"}],"standard_charges":[{"gross_charge":1970.02,"discounted_cash":1379.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 500 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002882427","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002882427","type":"NDC"}],"standard_charges":[{"gross_charge":2209.97,"discounted_cash":1546.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BELATACEPT FOR IV INFUSION 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003037113","type":"CDM"},{"code":"J0485","type":"HCPCS"},{"code":"00003037113","type":"NDC"}],"standard_charges":[{"gross_charge":4024.66,"discounted_cash":2817.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00003049420","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"APIXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089321","type":"CDM"},{"code":"00003089321","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.93,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089421","type":"CDM"},{"code":"00003089421","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.93,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6239.06,"discounted_cash":4367.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":55858.71,"discounted_cash":39101.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":223434.36,"discounted_cash":156404.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIVOLUMAB IV SOLN 240 MG/24ML","drug_information":{"unit":24.0,"type":"ML"},"code_information":[{"code":"Rx00003373413","type":"CDM"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"gross_charge":49000.88,"discounted_cash":34300.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9826.55,"discounted_cash":6878.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20416.91,"discounted_cash":14291.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20ML","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00003712511","type":"CDM"},{"code":"J9298","type":"HCPCS"},{"code":"00003712511","type":"NDC"}],"standard_charges":[{"gross_charge":190276.26,"discounted_cash":133193.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":375.53,"discounted_cash":262.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080085","type":"CDM"},{"code":"00004080085","type":"NDC"}],"standard_charges":[{"gross_charge":128.03,"discounted_cash":89.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 45 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080185","type":"CDM"},{"code":"00004080185","type":"NDC"}],"standard_charges":[{"gross_charge":120.96,"discounted_cash":84.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080285","type":"CDM"},{"code":"00004080285","type":"NDC"}],"standard_charges":[{"gross_charge":120.93,"discounted_cash":84.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1858.79,"discounted_cash":1301.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200010","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":1858.8,"discounted_cash":1301.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022101","type":"CDM"},{"code":"00006022101","type":"NDC"}],"standard_charges":[{"gross_charge":104.39,"discounted_cash":73.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":104.41,"discounted_cash":73.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":104.41,"discounted_cash":73.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":147.39,"discounted_cash":103.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006027701","type":"CDM"},{"code":"00006027701","type":"NDC"}],"standard_charges":[{"gross_charge":104.39,"discounted_cash":73.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SITAGLIPTIN PHOSPHATE TAB 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006027728","type":"CDM"},{"code":"00006027728","type":"NDC"}],"standard_charges":[{"gross_charge":104.41,"discounted_cash":73.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":104.4,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEZLOTOXUMAB IV SOLN 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00006302500","type":"CDM"},{"code":"J0565","type":"HCPCS"},{"code":"00006302500","type":"NDC"}],"standard_charges":[{"gross_charge":16598.41,"discounted_cash":11618.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEZLOTOXUMAB IV SOLN 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx00006302501","type":"CDM"},{"code":"J0565","type":"HCPCS"},{"code":"00006302501","type":"NDC"}],"standard_charges":[{"gross_charge":16598.41,"discounted_cash":11618.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMBROLIZUMAB IV SOLN 100 MG/4ML (25 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00006302601","type":"CDM"},{"code":"J9271","type":"HCPCS"},{"code":"00006302601","type":"NDC"}],"standard_charges":[{"gross_charge":37110.72,"discounted_cash":25977.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37110.72,"discounted_cash":25977.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":883.85,"discounted_cash":618.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006468101","type":"CDM"},{"code":"90707","type":"HCPCS"},{"code":"00006468101","type":"NDC"}],"standard_charges":[{"gross_charge":883.85,"discounted_cash":618.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1181.93,"discounted_cash":827.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":947.78,"discounted_cash":663.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1089.69,"discounted_cash":762.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 500 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00006542505","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542505","type":"NDC"}],"standard_charges":[{"gross_charge":1629.23,"discounted_cash":1140.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 500 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00006542515","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542515","type":"NDC"}],"standard_charges":[{"gross_charge":1995.89,"discounted_cash":1397.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092355","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092355","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":232.37,"discounted_cash":162.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":230.38,"discounted_cash":161.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001201","type":"CDM"},{"code":"00009001201","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001305","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001305","type":"NDC"}],"standard_charges":[{"gross_charge":431.98,"discounted_cash":302.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003101","type":"CDM"},{"code":"00009003101","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003930","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003930","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":83.75,"discounted_cash":58.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004725","type":"NDC"}],"standard_charges":[{"gross_charge":64.74,"discounted_cash":45.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009041701","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00009041701","type":"NDC"}],"standard_charges":[{"gross_charge":92.8,"discounted_cash":64.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":428.57,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009082501","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009082501","type":"NDC"}],"standard_charges":[{"gross_charge":151.98,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009085605","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"00009085605","type":"NDC"}],"standard_charges":[{"gross_charge":1290.69,"discounted_cash":903.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":648.64,"discounted_cash":454.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009087021","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009087021","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009087026","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307301","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307322","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307322","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307323","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307323","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPROSTADIL INJ 500 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009316901","type":"CDM"},{"code":"J0270","type":"HCPCS"},{"code":"00009316901","type":"NDC"}],"standard_charges":[{"gross_charge":1036.98,"discounted_cash":725.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1330.8,"discounted_cash":931.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":547.99,"discounted_cash":383.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00009514004","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00009514004","type":"NDC"}],"standard_charges":[{"gross_charge":306.5,"discounted_cash":214.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LYMPHOCYTE IMMUNE GLOBULIN ANTI-THYMOCYTE G INJ 50 MG/ML(EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009722401","type":"CDM"},{"code":"J7504","type":"HCPCS"},{"code":"00009722401","type":"NDC"}],"standard_charges":[{"gross_charge":20365.86,"discounted_cash":14256.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LYMPHOCYTE IMMUNE GLOBULIN ANTI-THYMOCYTE G INJ 50 MG/ML(EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009722402","type":"CDM"},{"code":"J7504","type":"HCPCS"},{"code":"00009722402","type":"NDC"}],"standard_charges":[{"gross_charge":20372.54,"discounted_cash":14260.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00009752903","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"00009752903","type":"NDC"}],"standard_charges":[{"gross_charge":212.43,"discounted_cash":148.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00013010110","type":"CDM"},{"code":"00013010110","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":15.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 5 MG/5ML (1 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00013257691","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00013257691","type":"NDC"}],"standard_charges":[{"gross_charge":583.97,"discounted_cash":408.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1167.56,"discounted_cash":817.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOTHALAMATE MEGLUMINE INJ 17.2%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00019086250","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLORIC ACID 1 NORMAL INJECTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00019368860","type":"CDM"},{"code":"00019368860","type":"NDC"}],"standard_charges":[{"gross_charge":246.84,"discounted_cash":172.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM (PF) OPHTH SOLN 0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023040350","type":"CDM"},{"code":"00023040350","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM (PF) OPHTH SOLN 0.5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023040370","type":"CDM"},{"code":"00023040370","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3992.28,"discounted_cash":2794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVONORGESTREL IUD 20.1 MCG/DAY (INITIAL) (52 MG TOTAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023585801","type":"CDM"},{"code":"J7297","type":"HCPCS"},{"code":"00023585801","type":"NDC"}],"standard_charges":[{"gross_charge":2653.61,"discounted_cash":1857.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00023608201","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00023608201","type":"NDC"}],"standard_charges":[{"gross_charge":74.88,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00023608210","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":74.91,"discounted_cash":52.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 10000-32000-42000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611001","type":"CDM"},{"code":"00023611001","type":"NDC"}],"standard_charges":[{"gross_charge":30.46,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 20000-63000-84000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023611201","type":"CDM"},{"code":"00023611201","type":"NDC"}],"standard_charges":[{"gross_charge":70.37,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISATUXIMAB-IRFC IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00024065401","type":"CDM"},{"code":"J9227","type":"HCPCS"},{"code":"00024065401","type":"NDC"}],"standard_charges":[{"gross_charge":6457.07,"discounted_cash":4519.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISATUXIMAB-IRFC IV SOLN 500 MG/25ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00024065601","type":"CDM"},{"code":"J9227","type":"HCPCS"},{"code":"00024065601","type":"NDC"}],"standard_charges":[{"gross_charge":26832.67,"discounted_cash":18782.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8216.89,"discounted_cash":5751.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RASBURICASE FOR IV SOLN 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024515175","type":"CDM"},{"code":"J2783","type":"HCPCS"},{"code":"00024515175","type":"NDC"}],"standard_charges":[{"gross_charge":34145.19,"discounted_cash":23901.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CABAZITAXEL INJ 60 MG/1.5ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00024582315","type":"CDM"},{"code":"J9043","type":"HCPCS"},{"code":"00024582315","type":"NDC"}],"standard_charges":[{"gross_charge":88579.03,"discounted_cash":62005.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CABAZITAXEL INJ 60 MG/1.5ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00024582411","type":"CDM"},{"code":"J9043","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":89907.68,"discounted_cash":62935.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5938.16,"discounted_cash":4156.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11350.96,"discounted_cash":7945.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DUPILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00024591400","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00024591400","type":"NDC"}],"standard_charges":[{"gross_charge":8037.01,"discounted_cash":5625.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DUPILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00024591401","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00024591401","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":8037.01,"discounted_cash":5625.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152034","type":"CDM"},{"code":"00025152034","type":"NDC"}],"standard_charges":[{"gross_charge":82.16,"discounted_cash":57.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":77.59,"discounted_cash":54.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032263601","type":"CDM"},{"code":"00032263601","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":55.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1199.51,"discounted_cash":839.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMOXINE HCL PERIANAL FOAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00037682315","type":"CDM"},{"code":"00037682315","type":"NDC"}],"standard_charges":[{"gross_charge":498.51,"discounted_cash":348.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3016.73,"discounted_cash":2111.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110181","type":"CDM"},{"code":"00046110181","type":"NDC"}],"standard_charges":[{"gross_charge":70.42,"discounted_cash":49.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":70.42,"discounted_cash":49.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001381","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001381","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001383","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001383","type":"NDC"}],"standard_charges":[{"gross_charge":60.89,"discounted_cash":42.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001481","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001481","type":"NDC"}],"standard_charges":[{"gross_charge":50.52,"discounted_cash":35.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001483","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"gross_charge":115.15,"discounted_cash":80.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052083","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052083","type":"NDC"}],"standard_charges":[{"gross_charge":102.24,"discounted_cash":71.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052084","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052084","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":495.93,"discounted_cash":347.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":585.2,"discounted_cash":409.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049396041","type":"CDM"},{"code":"00049396041","type":"NDC"}],"standard_charges":[{"gross_charge":119.58,"discounted_cash":83.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.73,"discounted_cash":11.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001920","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001920","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008813","type":"CDM"},{"code":"00054008813","type":"NDC"}],"standard_charges":[{"gross_charge":16.15,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054016325","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00054016325","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.5,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054022025","type":"CDM"},{"code":"00054022025","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023524","type":"CDM"},{"code":"00054023524","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITONAVIR TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054040713","type":"CDM"},{"code":"00054040713","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":26.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM CONC 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054306844","type":"CDM"},{"code":"00054306844","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.46,"discounted_cash":17.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM ORAL SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00054318863","type":"CDM"},{"code":"00054318863","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.58,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054353244","type":"CDM"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE ORAL SOLN 5 MG/5ML","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00054372250","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054372250","type":"NDC"}],"standard_charges":[{"gross_charge":317.24,"discounted_cash":222.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL ORAL SOLN 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054372763","type":"CDM"},{"code":"00054372763","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054414622","type":"CDM"},{"code":"00054414622","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054417925","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054417925","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418625","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418625","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054429725","type":"CDM"},{"code":"00054429725","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":26.6,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.91,"discounted_cash":13.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817925","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817925","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054818325","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054818325","type":"NDC"}],"standard_charges":[{"gross_charge":22.4,"discounted_cash":15.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852625","type":"CDM"},{"code":"00054852625","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017001","type":"CDM"},{"code":"00056017001","type":"NDC"}],"standard_charges":[{"gross_charge":23.97,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.97,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017201","type":"CDM"},{"code":"00056017201","type":"NDC"}],"standard_charges":[{"gross_charge":24.71,"discounted_cash":17.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBACHOL INTRAOCULAR INJ 0.01%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00065002315","type":"CDM"},{"code":"00065002315","type":"NDC"}],"standard_charges":[{"gross_charge":157.12,"discounted_cash":109.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAPHAZOLINE W/ PHENIRAMINE OPHTH SOLN 0.025-0.3%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00065008515","type":"CDM"},{"code":"00065008515","type":"NDC"}],"standard_charges":[{"gross_charge":59.67,"discounted_cash":41.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN SODIUM IV SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065009265","type":"CDM"},{"code":"A9612","type":"HCPCS"},{"code":"00065009265","type":"NDC"}],"standard_charges":[{"gross_charge":559.98,"discounted_cash":391.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065024610","type":"CDM"},{"code":"00065024610","type":"NDC"}],"standard_charges":[{"gross_charge":1840.63,"discounted_cash":1288.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POVIDONE-IODINE OPHTH SOLN 5%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00065041130","type":"CDM"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":99.98,"discounted_cash":69.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00065066010","type":"CDM"},{"code":"00065066010","type":"NDC"}],"standard_charges":[{"gross_charge":118.04,"discounted_cash":82.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065179504","type":"CDM"},{"code":"00065179504","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065179540","type":"CDM"},{"code":"00065179540","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00069023401","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069023401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00069023420","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069023420","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITUXIMAB-PVVR IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00069023801","type":"CDM"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801","type":"NDC"}],"standard_charges":[{"gross_charge":4527.96,"discounted_cash":3169.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00069024801","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069024801","type":"NDC"}],"standard_charges":[{"gross_charge":72.79,"discounted_cash":50.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00069024810","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069024810","type":"NDC"}],"standard_charges":[{"gross_charge":78.05,"discounted_cash":54.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITUXIMAB-PVVR IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069024901","type":"CDM"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":13891.73,"discounted_cash":9724.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":834.06,"discounted_cash":583.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":834.1,"discounted_cash":583.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00069029201","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029201","type":"NDC"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":766.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00069029210","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029210","type":"NDC"}],"standard_charges":[{"gross_charge":1094.98,"discounted_cash":766.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRASTUZUMAB-QYYP FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069030501","type":"CDM"},{"code":"Q5116","type":"HCPCS"},{"code":"00069030501","type":"NDC"}],"standard_charges":[{"gross_charge":13066.5,"discounted_cash":9146.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRASTUZUMAB-QYYP FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069030601","type":"CDM"},{"code":"Q5116","type":"HCPCS"},{"code":"00069030601","type":"NDC"}],"standard_charges":[{"gross_charge":14502.13,"discounted_cash":10151.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-BVZR IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00069031501","type":"CDM"},{"code":"Q5118","type":"HCPCS"},{"code":"00069031501","type":"NDC"}],"standard_charges":[{"gross_charge":5028.34,"discounted_cash":3519.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-BVZR IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx00069034201","type":"CDM"},{"code":"Q5118","type":"HCPCS"},{"code":"00069034201","type":"NDC"}],"standard_charges":[{"gross_charge":12341.51,"discounted_cash":8639.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":3602.08,"discounted_cash":2521.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":366.6,"discounted_cash":256.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":366.71,"discounted_cash":256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":916.5,"discounted_cash":641.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":916.81,"discounted_cash":641.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3007.94,"discounted_cash":2105.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130904","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":3008.92,"discounted_cash":2106.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069154220","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069154220","type":"NDC"}],"standard_charges":[{"gross_charge":731.72,"discounted_cash":512.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069303420","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069303420","type":"NDC"}],"standard_charges":[{"gross_charge":731.72,"discounted_cash":512.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069403401","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00069403401","type":"NDC"}],"standard_charges":[{"gross_charge":1510.6,"discounted_cash":1057.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRMATRELVIR TAB 10 X 150 MG & RITONAVIR TAB 10 X 100 MG PAK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069531702","type":"CDM"},{"code":"00069531702","type":"NDC"}],"standard_charges":[{"gross_charge":295.17,"discounted_cash":206.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRMATRELVIR TAB 10 X 150 MG & RITONAVIR TAB 10 X 100 MG PAK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069531720","type":"CDM"},{"code":"00069531720","type":"NDC"}],"standard_charges":[{"gross_charge":317.46,"discounted_cash":222.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRMATRELVIR TAB 20 X 150 MG & RITONAVIR TAB 10 X 100 MG PAK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069532103","type":"CDM"},{"code":"00069532103","type":"NDC"}],"standard_charges":[{"gross_charge":196.78,"discounted_cash":137.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRMATRELVIR TAB 20 X 150 MG & RITONAVIR TAB 10 X 100 MG PAK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069532130","type":"CDM"},{"code":"00069532130","type":"NDC"}],"standard_charges":[{"gross_charge":211.64,"discounted_cash":148.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069547401","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069547401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069547402","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069547402","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600102","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600110","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600110","type":"NDC"}],"standard_charges":[{"gross_charge":236.56,"discounted_cash":165.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":236.65,"discounted_cash":165.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600125","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600125","type":"NDC"}],"standard_charges":[{"gross_charge":394.42,"discounted_cash":276.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071000740","type":"CDM"},{"code":"00071000740","type":"NDC"}],"standard_charges":[{"gross_charge":24.27,"discounted_cash":16.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071036924","type":"CDM"},{"code":"00071036924","type":"NDC"}],"standard_charges":[{"gross_charge":21.76,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":89.18,"discounted_cash":62.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101341","type":"CDM"},{"code":"00071101341","type":"NDC"}],"standard_charges":[{"gross_charge":105.13,"discounted_cash":73.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101541","type":"CDM"},{"code":"00071101541","type":"NDC"}],"standard_charges":[{"gross_charge":105.13,"discounted_cash":73.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PARICALCITOL IV SOLN 5 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074165801","type":"CDM"},{"code":"J2501","type":"HCPCS"},{"code":"00074165801","type":"NDC"}],"standard_charges":[{"gross_charge":80.4,"discounted_cash":56.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.38,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074310932","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00074310932","type":"NDC"}],"standard_charges":[{"gross_charge":31.13,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR INJ KIT 3.75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074364103","type":"CDM"},{"code":"J1950","type":"HCPCS"},{"code":"00074364103","type":"NDC"}],"standard_charges":[{"gross_charge":9486.13,"discounted_cash":6640.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1886.62,"discounted_cash":1320.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR INJ KIT 11.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074366303","type":"CDM"},{"code":"J1950","type":"HCPCS"},{"code":"00074366303","type":"NDC"}],"standard_charges":[{"gross_charge":23652.0,"discounted_cash":16556.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISANKIZUMAB-RZAA IV SOLN 600 MG/10ML (60 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00074501501","type":"CDM"},{"code":"J2327","type":"HCPCS"},{"code":"00074501501","type":"NDC"}],"standard_charges":[{"gross_charge":36910.02,"discounted_cash":25837.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074659490","type":"CDM"},{"code":"00074659490","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706911","type":"CDM"},{"code":"00074706911","type":"NDC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074929690","type":"CDM"},{"code":"00074929690","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024015","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024015","type":"NDC"}],"standard_charges":[{"gross_charge":34.89,"discounted_cash":24.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024061","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"00078024061","type":"NDC"}],"standard_charges":[{"gross_charge":24.68,"discounted_cash":17.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024115","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078024115","type":"NDC"}],"standard_charges":[{"gross_charge":145.35,"discounted_cash":101.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078024161","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00078024161","type":"NDC"}],"standard_charges":[{"gross_charge":84.04,"discounted_cash":58.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":108.66,"discounted_cash":76.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078069620","type":"CDM"},{"code":"00078069620","type":"NDC"}],"standard_charges":[{"gross_charge":108.66,"discounted_cash":76.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00078072910","type":"CDM"},{"code":"00078072910","type":"NDC"}],"standard_charges":[{"gross_charge":2272.43,"discounted_cash":1590.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CANAKINUMAB SUBCUTANEOUS INJ 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00078073461","type":"CDM"},{"code":"J0638","type":"HCPCS"},{"code":"00078073461","type":"NDC"}],"standard_charges":[{"gross_charge":93407.91,"discounted_cash":65385.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078080461","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078080461","type":"NDC"}],"standard_charges":[{"gross_charge":25725.92,"discounted_cash":18008.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078081181","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078081181","type":"NDC"}],"standard_charges":[{"gross_charge":14040.66,"discounted_cash":9828.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078081301","type":"CDM"},{"code":"00078081301","type":"NDC"}],"standard_charges":[{"gross_charge":1838.17,"discounted_cash":1286.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18395.68,"discounted_cash":12876.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078082581","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00078082581","type":"NDC"}],"standard_charges":[{"gross_charge":27546.1,"discounted_cash":19282.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00078093926","type":"CDM"},{"code":"00078093926","type":"NDC"}],"standard_charges":[{"gross_charge":1318.93,"discounted_cash":923.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INCLISIRAN SODIUM SUBCUTANEOUS SOLN PREF SYR 284 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00078100060","type":"CDM"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":14809.44,"discounted_cash":10366.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SECUKINUMAB IV SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00078116861","type":"CDM"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":9468.39,"discounted_cash":6627.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMINS W/ IRON DROPS 11 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00087040501","type":"CDM"},{"code":"00087040501","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00087086644","type":"CDM"},{"code":"00087086644","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN GLARGINE SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00088221901","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088221901","type":"NDC"}],"standard_charges":[{"gross_charge":244.08,"discounted_cash":170.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN GLARGINE SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00088221905","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088221905","type":"NDC"}],"standard_charges":[{"gross_charge":143.55,"discounted_cash":100.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005301","type":"CDM"},{"code":"00093005301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005801","type":"CDM"},{"code":"00093005801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005805","type":"CDM"},{"code":"00093005805","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031401","type":"CDM"},{"code":"00093031401","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093078701","type":"CDM"},{"code":"00093078701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081001","type":"CDM"},{"code":"00093081001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081101","type":"CDM"},{"code":"00093081101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093117201","type":"CDM"},{"code":"00093117201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171201","type":"CDM"},{"code":"00093171201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093171301","type":"CDM"},{"code":"00093171301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.35,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093227434","type":"CDM"},{"code":"00093227434","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUININE SULFATE CAP 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093300256","type":"CDM"},{"code":"00093300256","type":"NDC"}],"standard_charges":[{"gross_charge":62.21,"discounted_cash":43.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093310953","type":"CDM"},{"code":"00093310953","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312301","type":"CDM"},{"code":"00093312301","type":"NDC"}],"standard_charges":[{"gross_charge":17.27,"discounted_cash":12.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365621","type":"CDM"},{"code":"00093365621","type":"NDC"}],"standard_charges":[{"gross_charge":156.37,"discounted_cash":109.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365640","type":"CDM"},{"code":"00093365640","type":"NDC"}],"standard_charges":[{"gross_charge":160.92,"discounted_cash":112.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.63,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414619","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414619","type":"NDC"}],"standard_charges":[{"gross_charge":18.06,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414645","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414645","type":"NDC"}],"standard_charges":[{"gross_charge":18.97,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414656","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414656","type":"NDC"}],"standard_charges":[{"gross_charge":19.06,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00093414845","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"00093414845","type":"NDC"}],"standard_charges":[{"gross_charge":19.81,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.29,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093598519","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00093598519","type":"NDC"}],"standard_charges":[{"gross_charge":1206.26,"discounted_cash":844.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093598619","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00093598619","type":"NDC"}],"standard_charges":[{"gross_charge":1213.77,"discounted_cash":849.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681519","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681519","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":19.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681555","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681555","type":"NDC"}],"standard_charges":[{"gross_charge":23.84,"discounted_cash":16.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":73.25,"discounted_cash":51.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681619","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681619","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":19.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681645","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681645","type":"NDC"}],"standard_charges":[{"gross_charge":22.07,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681655","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681655","type":"NDC"}],"standard_charges":[{"gross_charge":30.31,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681673","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":81.45,"discounted_cash":57.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093727156","type":"CDM"},{"code":"00093727156","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093735598","type":"CDM"},{"code":"00093735598","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.08,"discounted_cash":14.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093902019","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093902019","type":"NDC"}],"standard_charges":[{"gross_charge":22.99,"discounted_cash":16.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093902065","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093902065","type":"NDC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093929119","type":"CDM"},{"code":"00093929119","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093929167","type":"CDM"},{"code":"00093929167","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":12.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115101101","type":"CDM"},{"code":"00115101101","type":"NDC"}],"standard_charges":[{"gross_charge":15.49,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169606","type":"CDM"},{"code":"00115169606","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169701","type":"CDM"},{"code":"00115169701","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115180301","type":"CDM"},{"code":"00115180301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLESTIPOL HCL TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115521116","type":"CDM"},{"code":"00115521116","type":"NDC"}],"standard_charges":[{"gross_charge":17.38,"discounted_cash":12.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116400530","type":"CDM"},{"code":"00116400530","type":"NDC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116400541","type":"CDM"},{"code":"00116400541","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7.2,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00121050404","type":"CDM"},{"code":"00121050404","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.69,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121077001","type":"CDM"},{"code":"00121077001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121077516","type":"CDM"},{"code":"00121077516","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.21,"discounted_cash":16.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086800","type":"CDM"},{"code":"00121086800","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086805","type":"CDM"},{"code":"00121086805","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121087332","type":"CDM"},{"code":"00121087332","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 5 MG/5ML (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121090204","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121090204","type":"NDC"}],"standard_charges":[{"gross_charge":87.43,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090315","type":"CDM"},{"code":"00121090315","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090340","type":"CDM"},{"code":"00121090340","type":"NDC"}],"standard_charges":[{"gross_charge":19.57,"discounted_cash":13.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090405","type":"CDM"},{"code":"00121090405","type":"NDC"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090494","type":"CDM"},{"code":"00121090494","type":"NDC"}],"standard_charges":[{"gross_charge":17.02,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00121097251","type":"CDM"},{"code":"00121097251","type":"NDC"}],"standard_charges":[{"gross_charge":161.58,"discounted_cash":113.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121097800","type":"CDM"},{"code":"00121097800","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115400","type":"CDM"},{"code":"00121115400","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.95,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5.28,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121148800","type":"CDM"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121148810","type":"CDM"},{"code":"00121148810","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.51,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.17,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121166600","type":"CDM"},{"code":"00121166600","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121166610","type":"CDM"},{"code":"00121166610","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6.24,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121177500","type":"CDM"},{"code":"00121177500","type":"NDC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.5,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121177540","type":"CDM"},{"code":"00121177540","type":"NDC"}],"standard_charges":[{"gross_charge":29.07,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121182800","type":"CDM"},{"code":"00121182800","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121182810","type":"CDM"},{"code":"00121182810","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121187000","type":"CDM"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121187010","type":"CDM"},{"code":"00121187010","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00121197100","type":"CDM"},{"code":"00121197100","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00121197121","type":"CDM"},{"code":"00121197121","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121231615","type":"CDM"},{"code":"00121231615","type":"NDC"}],"standard_charges":[{"gross_charge":21.77,"discounted_cash":15.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467500","type":"CDM"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":20.61,"discounted_cash":14.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467505","type":"CDM"},{"code":"00121467505","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467540","type":"CDM"},{"code":"00121467540","type":"NDC"}],"standard_charges":[{"gross_charge":24.72,"discounted_cash":17.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121472105","type":"CDM"},{"code":"00121472105","type":"NDC"}],"standard_charges":[{"gross_charge":24.69,"discounted_cash":17.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121482705","type":"CDM"},{"code":"00121482705","type":"NDC"}],"standard_charges":[{"gross_charge":31.99,"discounted_cash":22.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121482740","type":"CDM"},{"code":"00121482740","type":"NDC"}],"standard_charges":[{"gross_charge":38.43,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.59,"discounted_cash":15.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.81,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121495594","type":"CDM"},{"code":"00121495594","type":"NDC"}],"standard_charges":[{"gross_charge":19.06,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":234.36,"discounted_cash":164.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":117.27,"discounted_cash":82.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00131247860","type":"CDM"},{"code":"00131247860","type":"NDC"}],"standard_charges":[{"gross_charge":159.46,"discounted_cash":111.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00132007912","type":"CDM"},{"code":"00132007912","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00132020140","type":"CDM"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":8.77,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA (PEDIATRIC)","drug_information":{"unit":33.0,"type":"ML"},"code_information":[{"code":"Rx00132020220","type":"CDM"},{"code":"00132020220","type":"NDC"}],"standard_charges":[{"gross_charge":5.14,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINERAL OIL ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00132030140","type":"CDM"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143117101","type":"CDM"},{"code":"00143117101","type":"NDC"}],"standard_charges":[{"gross_charge":18.79,"discounted_cash":13.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143124001","type":"CDM"},{"code":"00143124001","type":"NDC"}],"standard_charges":[{"gross_charge":15.51,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143211250","type":"CDM"},{"code":"00143211250","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143902201","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00143902201","type":"NDC"}],"standard_charges":[{"gross_charge":663.65,"discounted_cash":464.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143902202","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"00143902202","type":"NDC"}],"standard_charges":[{"gross_charge":426.77,"discounted_cash":298.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143908701","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143908701","type":"NDC"}],"standard_charges":[{"gross_charge":1492.0,"discounted_cash":1044.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143909101","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143909101","type":"NDC"}],"standard_charges":[{"gross_charge":351.17,"discounted_cash":245.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143909801","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"00143909801","type":"NDC"}],"standard_charges":[{"gross_charge":181.28,"discounted_cash":126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143913601","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143913601","type":"NDC"}],"standard_charges":[{"gross_charge":1262.18,"discounted_cash":883.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR IV SOLN 3 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143914001","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143914001","type":"NDC"}],"standard_charges":[{"gross_charge":48.27,"discounted_cash":33.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143914101","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00143914101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143914110","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00143914110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916101","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916125","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916210","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143918401","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"00143918401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143918425","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"00143918425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143921001","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"00143921001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143921010","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"00143921010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924501","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00143924501","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924510","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00143924510","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143924801","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"00143924801","type":"NDC"}],"standard_charges":[{"gross_charge":1225.21,"discounted_cash":857.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143925001","type":"CDM"},{"code":"00143925001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143925010","type":"CDM"},{"code":"00143925010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143926201","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143926201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143926225","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143926225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143927301","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00143927301","type":"NDC"}],"standard_charges":[{"gross_charge":700.13,"discounted_cash":490.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143927310","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00143927310","type":"NDC"}],"standard_charges":[{"gross_charge":395.1,"discounted_cash":276.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR INJ 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928001","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"00143928001","type":"NDC"}],"standard_charges":[{"gross_charge":1262.18,"discounted_cash":883.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00143929801","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143929801","type":"NDC"}],"standard_charges":[{"gross_charge":62.92,"discounted_cash":44.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00143929810","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143929810","type":"NDC"}],"standard_charges":[{"gross_charge":68.49,"discounted_cash":47.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931101","type":"CDM"},{"code":"00143931101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931110","type":"CDM"},{"code":"00143931110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143931701","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143931724","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143931724","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00143931801","type":"CDM"},{"code":"00143931801","type":"NDC"}],"standard_charges":[{"gross_charge":49.98,"discounted_cash":34.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933101","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933101","type":"NDC"}],"standard_charges":[{"gross_charge":121.55,"discounted_cash":85.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933110","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933310","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933401","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143933410","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00143933410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143936101","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"00143936101","type":"NDC"}],"standard_charges":[{"gross_charge":96.47,"discounted_cash":67.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143937201","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143937201","type":"NDC"}],"standard_charges":[{"gross_charge":343.51,"discounted_cash":240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143937601","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143937601","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":50.0,"type":"ML"},"code_information":[{"code":"Rx00143937901","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00143937901","type":"NDC"}],"standard_charges":[{"gross_charge":87.22,"discounted_cash":61.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":50.0,"type":"ML"},"code_information":[{"code":"Rx00143937910","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00143937910","type":"NDC"}],"standard_charges":[{"gross_charge":63.39,"discounted_cash":44.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938301","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00143938301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938310","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"00143938310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143938401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"00143938401","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939101","type":"CDM"},{"code":"00143939101","type":"NDC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939110","type":"CDM"},{"code":"00143939110","type":"NDC"}],"standard_charges":[{"gross_charge":307.52,"discounted_cash":215.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143939310","type":"CDM"},{"code":"00143939310","type":"NDC"}],"standard_charges":[{"gross_charge":2412.91,"discounted_cash":1689.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143950301","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":238.97,"discounted_cash":167.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950701","type":"CDM"},{"code":"00143950701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":36.84,"discounted_cash":25.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.93,"discounted_cash":31.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950901","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950910","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950910","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143951001","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143951001","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00143951101","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"00143951101","type":"NDC"}],"standard_charges":[{"gross_charge":345.42,"discounted_cash":241.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951401","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951425","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143951525","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00143951525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143952501","type":"CDM"},{"code":"00143952501","type":"NDC"}],"standard_charges":[{"gross_charge":274.51,"discounted_cash":192.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":97.86,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00143954601","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"00143954601","type":"NDC"}],"standard_charges":[{"gross_charge":343.51,"discounted_cash":240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143955201","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"00143955201","type":"NDC"}],"standard_charges":[{"gross_charge":192.15,"discounted_cash":134.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956401","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"gross_charge":3725.87,"discounted_cash":2608.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956410","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"00143956410","type":"NDC"}],"standard_charges":[{"gross_charge":3725.87,"discounted_cash":2608.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00143957001","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957001","type":"NDC"}],"standard_charges":[{"gross_charge":62.92,"discounted_cash":44.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00143957010","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":68.49,"discounted_cash":47.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143959301","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143959301","type":"NDC"}],"standard_charges":[{"gross_charge":127.34,"discounted_cash":89.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959401","type":"CDM"},{"code":"00143959401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959425","type":"CDM"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959501","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00143959501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959525","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00143959525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":726.52,"discounted_cash":508.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":536.64,"discounted_cash":375.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143963801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"00143963801","type":"NDC"}],"standard_charges":[{"gross_charge":68.28,"discounted_cash":47.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143963805","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"00143963805","type":"NDC"}],"standard_charges":[{"gross_charge":48.04,"discounted_cash":33.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968201","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143968901","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143968901","type":"NDC"}],"standard_charges":[{"gross_charge":127.34,"discounted_cash":89.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.21,"discounted_cash":56.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":145.47,"discounted_cash":101.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143970901","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143970901","type":"NDC"}],"standard_charges":[{"gross_charge":48.23,"discounted_cash":33.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00143970910","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143970910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 40 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143971801","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971801","type":"NDC"}],"standard_charges":[{"gross_charge":142.96,"discounted_cash":100.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 40 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00143971810","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"00143971810","type":"NDC"}],"standard_charges":[{"gross_charge":91.9,"discounted_cash":64.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":47.23,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.8,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00143972201","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":45.95,"discounted_cash":32.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":86.47,"discounted_cash":60.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972901","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143972901","type":"NDC"}],"standard_charges":[{"gross_charge":226.14,"discounted_cash":158.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972905","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143972905","type":"NDC"}],"standard_charges":[{"gross_charge":100.51,"discounted_cash":70.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143974601","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"00143974601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143978501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143978510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143983701","type":"CDM"},{"code":"00143983701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985101","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00143985101","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985601","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985625","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985625","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985725","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987501","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987525","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987701","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987701","type":"NDC"}],"standard_charges":[{"gross_charge":152.9,"discounted_cash":107.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987725","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143988750","type":"CDM"},{"code":"00143988750","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992390","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143992390","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992701","type":"CDM"},{"code":"00143992701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000415","type":"CDM"},{"code":"00168000415","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.4,"discounted_cash":56.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE VAGINAL CREAM 2%","drug_information":{"unit":40.0,"type":"GM"},"code_information":[{"code":"Rx00168027740","type":"CDM"},{"code":"00168027740","type":"NDC"}],"standard_charges":[{"gross_charge":609.63,"discounted_cash":426.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE CREAM 0.75%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00168032346","type":"CDM"},{"code":"00168032346","type":"NDC"}],"standard_charges":[{"gross_charge":308.78,"discounted_cash":216.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035705","type":"CDM"},{"code":"00168035705","type":"NDC"}],"standard_charges":[{"gross_charge":94.97,"discounted_cash":66.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":94.97,"discounted_cash":66.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":393.7,"discounted_cash":275.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169300301","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169300301","type":"NDC"}],"standard_charges":[{"gross_charge":497.89,"discounted_cash":348.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169300315","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169300315","type":"NDC"}],"standard_charges":[{"gross_charge":142.15,"discounted_cash":99.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COAGULATION FACTOR VIIA (RECOMB) FOR INJ 2 MG (2000 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00169720201","type":"CDM"},{"code":"J7189","type":"HCPCS"},{"code":"00169720201","type":"NDC"}],"standard_charges":[{"gross_charge":20553.1,"discounted_cash":14387.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52890.19,"discounted_cash":37023.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":378.53,"discounted_cash":264.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172392660","type":"CDM"},{"code":"00172392660","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172541279","type":"CDM"},{"code":"00172541279","type":"NDC"}],"standard_charges":[{"gross_charge":26.93,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00173068224","type":"CDM"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":181.9,"discounted_cash":127.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173071215","type":"CDM"},{"code":"00173071215","type":"NDC"}],"standard_charges":[{"gross_charge":78.27,"discounted_cash":54.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14163.58,"discounted_cash":9914.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":16762.29,"discounted_cash":11733.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOSTARLIMAB-GXLY IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00173089803","type":"CDM"},{"code":"J9272","type":"HCPCS"},{"code":"00173089803","type":"NDC"}],"standard_charges":[{"gross_charge":74214.74,"discounted_cash":51950.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185005501","type":"CDM"},{"code":"00185005501","type":"NDC"}],"standard_charges":[{"gross_charge":16.67,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185012901","type":"CDM"},{"code":"00185012901","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":493.37,"discounted_cash":345.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":493.37,"discounted_cash":345.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":74.33,"discounted_cash":52.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187065820","type":"CDM"},{"code":"00187065820","type":"NDC"}],"standard_charges":[{"gross_charge":711.79,"discounted_cash":498.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00223176001","type":"CDM"},{"code":"00223176001","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00225080547","type":"CDM"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"gross_charge":26.37,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00225081047","type":"CDM"},{"code":"00225081047","type":"NDC"}],"standard_charges":[{"gross_charge":29.61,"discounted_cash":20.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228212710","type":"CDM"},{"code":"00228212710","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx00234057504","type":"CDM"},{"code":"00234057504","type":"NDC"}],"standard_charges":[{"gross_charge":31.15,"discounted_cash":21.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001201","type":"CDM"},{"code":"00245001201","type":"NDC"}],"standard_charges":[{"gross_charge":18.83,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001289","type":"CDM"},{"code":"00245001289","type":"NDC"}],"standard_charges":[{"gross_charge":19.93,"discounted_cash":13.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014401","type":"CDM"},{"code":"00245014401","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014430","type":"CDM"},{"code":"00245014430","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245014489","type":"CDM"},{"code":"00245014489","type":"NDC"}],"standard_charges":[{"gross_charge":28.82,"discounted_cash":20.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021201","type":"CDM"},{"code":"00245021201","type":"NDC"}],"standard_charges":[{"gross_charge":18.06,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021211","type":"CDM"},{"code":"00245021211","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245021289","type":"CDM"},{"code":"00245021289","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":19.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00245086070","type":"CDM"},{"code":"00245086070","type":"NDC"}],"standard_charges":[{"gross_charge":295.11,"discounted_cash":206.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531701","type":"CDM"},{"code":"00245531701","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531789","type":"CDM"},{"code":"00245531789","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531901","type":"CDM"},{"code":"00245531901","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531911","type":"CDM"},{"code":"00245531911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531989","type":"CDM"},{"code":"00245531989","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00254200811","type":"CDM"},{"code":"00254200811","type":"NDC"}],"standard_charges":[{"gross_charge":61.69,"discounted_cash":43.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":334.88,"discounted_cash":234.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00264405080","type":"CDM"},{"code":"J0136","type":"HCPCS"},{"code":"00264405080","type":"NDC"}],"standard_charges":[{"gross_charge":63.27,"discounted_cash":44.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00264405090","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"00264405090","type":"NDC"}],"standard_charges":[{"gross_charge":50.16,"discounted_cash":35.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00264410090","type":"CDM"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx00264410095","type":"CDM"},{"code":"J0136","type":"HCPCS"},{"code":"00264410095","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264420654","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00264420654","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264762320","type":"CDM"},{"code":"00264762320","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264780000","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00264780000","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780010","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00264780010","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00264987200","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00264987200","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIATRIZOATE MEGLUMINE URETHRAL SOLN 30%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00270014957","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014957","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIATRIZOATE MEGLUMINE URETHRAL SOLN 30%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270014960","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014960","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 41%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00270131415","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270131415","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 41%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00270131430","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270131430","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 61%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00270131530","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 61%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131535","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":99.6,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131635","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":116.1,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL INJ 51%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131702","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270131702","type":"NDC"}],"standard_charges":[{"gross_charge":97.8,"discounted_cash":68.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL INJ 51%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00270131709","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270131709","type":"NDC"}],"standard_charges":[{"gross_charge":126.9,"discounted_cash":88.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIATRIZOATE MEGLUMINE INJ 18%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00270141030","type":"CDM"},{"code":"Q9958","type":"HCPCS"},{"code":"00270141030","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL INJ 41%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00270141111","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141111","type":"NDC"}],"standard_charges":[{"gross_charge":100.53,"discounted_cash":70.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL INJ 41%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00270141125","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141125","type":"NDC"}],"standard_charges":[{"gross_charge":138.18,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOPAMIDOL INJ 61%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00270141215","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":93.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.13,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00281032660","type":"CDM"},{"code":"00281032660","type":"NDC"}],"standard_charges":[{"gross_charge":289.18,"discounted_cash":202.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZOCAINE DENTAL SOLN 20%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00283061026","type":"CDM"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZOCAINE DENTAL SOLN 20%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00283061043","type":"CDM"},{"code":"00283061043","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":125.84,"discounted_cash":88.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310110539","type":"CDM"},{"code":"00310110539","type":"NDC"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310111001","type":"CDM"},{"code":"00310111001","type":"NDC"}],"standard_charges":[{"gross_charge":31.71,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310111030","type":"CDM"},{"code":"00310111030","type":"NDC"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE FOR SUSP PACKET 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310111039","type":"CDM"},{"code":"00310111039","type":"NDC"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENRALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 30 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00310173030","type":"CDM"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":22603.1,"discounted_cash":15822.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANIFROLUMAB-FNIA IV SOLN 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00310304000","type":"CDM"},{"code":"J0491","type":"HCPCS"},{"code":"00310304000","type":"NDC"}],"standard_charges":[{"gross_charge":23765.0,"discounted_cash":16635.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DURVALUMAB SOLN FOR IV INFUSION 120 MG/2.4ML (50 MG/ML)","drug_information":{"unit":2.4,"type":"ML"},"code_information":[{"code":"Rx00310450012","type":"CDM"},{"code":"J9173","type":"HCPCS"},{"code":"00310450012","type":"NDC"}],"standard_charges":[{"gross_charge":7650.75,"discounted_cash":5355.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TREMELIMUMAB-ACTL SOLN FOR IV INFUSION 300 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00310453530","type":"CDM"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":255317.08,"discounted_cash":178721.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DURVALUMAB SOLN FOR IV INFUSION 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00310461150","type":"CDM"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"gross_charge":26493.77,"discounted_cash":18545.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CITRIC ACID-GLUCONOLACTONE-MAGNESIUM CARBONATE SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00327001230","type":"CDM"},{"code":"00327001230","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338000403","type":"CDM"},{"code":"00338000403","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338001304","type":"CDM"},{"code":"00338001304","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":52.62,"discounted_cash":36.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338001702","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001702","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001711","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001711","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001731","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001731","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002303","type":"CDM"},{"code":"00338002303","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004303","type":"CDM"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338004727","type":"CDM"},{"code":"00338004727","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004802","type":"CDM"},{"code":"00338004802","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004803","type":"CDM"},{"code":"00338004803","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004902","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004902","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004918","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00338006301","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006301","type":"NDC"}],"standard_charges":[{"gross_charge":1389.98,"discounted_cash":972.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00338006701","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006701","type":"NDC"}],"standard_charges":[{"gross_charge":3470.02,"discounted_cash":2429.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00338007225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00338007704","type":"CDM"},{"code":"00338007704","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008503","type":"CDM"},{"code":"00338008503","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338011702","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011702","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338011703","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338011704","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338012612","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"gross_charge":125.09,"discounted_cash":87.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":432.09,"discounted_cash":302.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THROMBIN (RECOMBINANT) FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00338032401","type":"CDM"},{"code":"00338032401","type":"NDC"}],"standard_charges":[{"gross_charge":432.09,"discounted_cash":302.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338042418","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00338042418","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338043103","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00338043103","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338043304","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00338043304","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":447.72,"discounted_cash":313.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID INFUSION 15%","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338050206","type":"CDM"},{"code":"00338050206","type":"NDC"}],"standard_charges":[{"gross_charge":509.6,"discounted_cash":356.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338055111","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338055111","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338080304","type":"CDM"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":78.71,"discounted_cash":55.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":103.04,"discounted_cash":72.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":140.41,"discounted_cash":98.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":407.68,"discounted_cash":285.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":480.48,"discounted_cash":336.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338112504","type":"CDM"},{"code":"00338112504","type":"NDC"}],"standard_charges":[{"gross_charge":495.04,"discounted_cash":346.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID INFUSION 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338113003","type":"CDM"},{"code":"00338113003","type":"NDC"}],"standard_charges":[{"gross_charge":196.56,"discounted_cash":137.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":254.8,"discounted_cash":178.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338114803","type":"CDM"},{"code":"00338114803","type":"NDC"}],"standard_charges":[{"gross_charge":291.2,"discounted_cash":203.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":292.68,"discounted_cash":204.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338170940","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":51.48,"discounted_cash":36.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":51.48,"discounted_cash":36.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338702201","type":"CDM"},{"code":"00338702201","type":"NDC"}],"standard_charges":[{"gross_charge":254.8,"discounted_cash":178.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338702206","type":"CDM"},{"code":"00338702206","type":"NDC"}],"standard_charges":[{"gross_charge":240.24,"discounted_cash":168.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338702401","type":"CDM"},{"code":"00338702401","type":"NDC"}],"standard_charges":[{"gross_charge":422.24,"discounted_cash":295.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D5W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338702404","type":"CDM"},{"code":"00338702404","type":"NDC"}],"standard_charges":[{"gross_charge":422.24,"discounted_cash":295.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338703401","type":"CDM"},{"code":"00338703401","type":"NDC"}],"standard_charges":[{"gross_charge":349.44,"discounted_cash":244.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338703406","type":"CDM"},{"code":"00338703406","type":"NDC"}],"standard_charges":[{"gross_charge":291.2,"discounted_cash":203.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338703601","type":"CDM"},{"code":"00338703601","type":"NDC"}],"standard_charges":[{"gross_charge":495.04,"discounted_cash":346.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D20W","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx00338703604","type":"CDM"},{"code":"00338703604","type":"NDC"}],"standard_charges":[{"gross_charge":495.04,"discounted_cash":346.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.75,"discounted_cash":78.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954003","type":"CDM"},{"code":"00338954003","type":"NDC"}],"standard_charges":[{"gross_charge":168.07,"discounted_cash":117.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954006","type":"CDM"},{"code":"00338954006","type":"NDC"}],"standard_charges":[{"gross_charge":119.14,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY/OLIVE) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954007","type":"CDM"},{"code":"00338954007","type":"NDC"}],"standard_charges":[{"gross_charge":72.33,"discounted_cash":50.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338954302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338954302","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338954303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338954303","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338954305","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00338954305","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":139.56,"discounted_cash":97.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00338966701","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"00338966701","type":"NDC"}],"standard_charges":[{"gross_charge":3411.05,"discounted_cash":2387.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":1.8,"type":"ML"},"code_information":[{"code":"Rx00362055705","type":"CDM"},{"code":"00362055705","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00362901110","type":"CDM"},{"code":"00362901110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":1.8,"type":"ML"},"code_information":[{"code":"Rx00362901150","type":"CDM"},{"code":"00362901150","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIMOLOL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378005501","type":"CDM"},{"code":"00378005501","type":"NDC"}],"standard_charges":[{"gross_charge":19.12,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378021601","type":"CDM"},{"code":"00378021601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087116","type":"CDM"},{"code":"00378087116","type":"NDC"}],"standard_charges":[{"gross_charge":141.77,"discounted_cash":99.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.48,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087216","type":"CDM"},{"code":"00378087216","type":"NDC"}],"standard_charges":[{"gross_charge":126.22,"discounted_cash":88.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.2 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087299","type":"CDM"},{"code":"00378087299","type":"NDC"}],"standard_charges":[{"gross_charge":189.39,"discounted_cash":132.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378092493","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00378092493","type":"NDC"}],"standard_charges":[{"gross_charge":21.82,"discounted_cash":15.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378110101","type":"CDM"},{"code":"00378110101","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378115001","type":"CDM"},{"code":"00378115001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180077","type":"CDM"},{"code":"00378180077","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180377","type":"CDM"},{"code":"00378180377","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180577","type":"CDM"},{"code":"00378180577","type":"NDC"}],"standard_charges":[{"gross_charge":16.03,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180977","type":"CDM"},{"code":"00378180977","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378181177","type":"CDM"},{"code":"00378181177","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":11.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378210001","type":"CDM"},{"code":"00378210001","type":"NDC"}],"standard_charges":[{"gross_charge":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378623101","type":"CDM"},{"code":"00378623101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378623201","type":"CDM"},{"code":"00378623201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378632001","type":"CDM"},{"code":"00378632001","type":"NDC"}],"standard_charges":[{"gross_charge":19.51,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00378699889","type":"CDM"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378907016","type":"CDM"},{"code":"00378907016","type":"NDC"}],"standard_charges":[{"gross_charge":62.06,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378907093","type":"CDM"},{"code":"00378907093","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911216","type":"CDM"},{"code":"00378911216","type":"NDC"}],"standard_charges":[{"gross_charge":17.39,"discounted_cash":12.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.56,"discounted_cash":12.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911916","type":"CDM"},{"code":"00378911916","type":"NDC"}],"standard_charges":[{"gross_charge":140.11,"discounted_cash":98.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":140.11,"discounted_cash":98.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912116","type":"CDM"},{"code":"00378912116","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":49.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912198","type":"CDM"},{"code":"00378912198","type":"NDC"}],"standard_charges":[{"gross_charge":71.4,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912316","type":"CDM"},{"code":"00378912316","type":"NDC"}],"standard_charges":[{"gross_charge":156.5,"discounted_cash":109.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912398","type":"CDM"},{"code":"00378912398","type":"NDC"}],"standard_charges":[{"gross_charge":156.89,"discounted_cash":109.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912416","type":"CDM"},{"code":"00378912416","type":"NDC"}],"standard_charges":[{"gross_charge":118.26,"discounted_cash":82.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912498","type":"CDM"},{"code":"00378912498","type":"NDC"}],"standard_charges":[{"gross_charge":118.65,"discounted_cash":83.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967131","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967131","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967193","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ORAL VEHICLES - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395009016","type":"CDM"},{"code":"00395009016","type":"NDC"}],"standard_charges":[{"gross_charge":175.75,"discounted_cash":123.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMPLE - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395266116","type":"CDM"},{"code":"00395266116","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":65.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":85.14,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012323","type":"CDM"},{"code":"00406012323","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012362","type":"CDM"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"gross_charge":16.53,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012423","type":"CDM"},{"code":"00406012423","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012462","type":"CDM"},{"code":"00406012462","type":"NDC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048462","type":"CDM"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051223","type":"CDM"},{"code":"00406051223","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.42,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406052323","type":"CDM"},{"code":"00406052323","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":15.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406052362","type":"CDM"},{"code":"00406052362","type":"NDC"}],"standard_charges":[{"gross_charge":24.84,"discounted_cash":17.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055223","type":"CDM"},{"code":"00406055223","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055262","type":"CDM"},{"code":"00406055262","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406114201","type":"CDM"},{"code":"00406114201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406324301","type":"CDM"},{"code":"00406324301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406511823","type":"CDM"},{"code":"00406511823","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406511862","type":"CDM"},{"code":"00406511862","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577123","type":"CDM"},{"code":"00406577123","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577162","type":"CDM"},{"code":"00406577162","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00406800330","type":"CDM"},{"code":"00406800330","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831523","type":"CDM"},{"code":"00406831523","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.61,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851023","type":"CDM"},{"code":"00406851023","type":"NDC"}],"standard_charges":[{"gross_charge":17.38,"discounted_cash":12.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851062","type":"CDM"},{"code":"00406851062","type":"NDC"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406889201","type":"CDM"},{"code":"00406889201","type":"NDC"}],"standard_charges":[{"gross_charge":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406911276","type":"CDM"},{"code":"00406911276","type":"NDC"}],"standard_charges":[{"gross_charge":135.29,"discounted_cash":94.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406912576","type":"CDM"},{"code":"00406912576","type":"NDC"}],"standard_charges":[{"gross_charge":71.4,"discounted_cash":49.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406915076","type":"CDM"},{"code":"00406915076","type":"NDC"}],"standard_charges":[{"gross_charge":114.83,"discounted_cash":80.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL IV SOLN 140 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407140152","type":"CDM"},{"code":"Q9965","type":"HCPCS"},{"code":"00407140152","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 180 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00407141110","type":"CDM"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141110","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 180 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00407141120","type":"CDM"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141120","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141230","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407141234","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141234","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 240 MG/ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00407141235","type":"CDM"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141235","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141361","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141363","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141363","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141386","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141386","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00407141387","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141387","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141489","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141489","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IOHEXOL IV SOLN 350 MG/ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00407141494","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141494","type":"NDC"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IODIXANOL INJ 320 MG/ML (IODINE EQUIVALENT)","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00407222319","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222319","type":"NDC"}],"standard_charges":[{"gross_charge":144.45,"discounted_cash":101.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409000101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409000101","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409000125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409000125","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409014701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409014701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409014710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409014710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015201","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":340.55,"discounted_cash":238.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx00409018301","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx00409020120","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"00409020120","type":"NDC"}],"standard_charges":[{"gross_charge":1560.61,"discounted_cash":1092.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409100501","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409100501","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409100520","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409100520","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409106720","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"00409106720","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115902","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115919","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115919","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116219","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116219","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116518","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116518","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120703","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120703","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120713","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120713","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120715","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120715","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127303","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127303","type":"NDC"}],"standard_charges":[{"gross_charge":92.85,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127332","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":92.85,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128303","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128317","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128317","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128337","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 4 MG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00409130403","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409130403","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 4 MG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00409130431","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409130431","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409132305","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":51.61,"discounted_cash":36.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409132315","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132315","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALBUPHINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409146371","type":"CDM"},{"code":"J2300","type":"HCPCS"},{"code":"00409146371","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409154101","type":"CDM"},{"code":"00409154101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409154110","type":"CDM"},{"code":"00409154110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156019","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156019","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156029","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156029","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409159601","type":"CDM"},{"code":"00409159601","type":"NDC"}],"standard_charges":[{"gross_charge":139.56,"discounted_cash":97.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409159610","type":"CDM"},{"code":"00409159610","type":"NDC"}],"standard_charges":[{"gross_charge":454.08,"discounted_cash":317.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":84.07,"discounted_cash":58.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162321","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162321","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409163010","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409163015","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409163015","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409163110","type":"CDM"},{"code":"00409163110","type":"NDC"}],"standard_charges":[{"gross_charge":101.46,"discounted_cash":71.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409163140","type":"CDM"},{"code":"00409163140","type":"NDC"}],"standard_charges":[{"gross_charge":54.28,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174610","type":"CDM"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174630","type":"CDM"},{"code":"00409174630","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174671","type":"CDM"},{"code":"00409174671","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174929","type":"CDM"},{"code":"00409174929","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174971","type":"CDM"},{"code":"00409174971","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409175550","type":"CDM"},{"code":"00409175550","type":"NDC"}],"standard_charges":[{"gross_charge":139.88,"discounted_cash":97.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177540","type":"CDM"},{"code":"00409177540","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409177805","type":"CDM"},{"code":"00409177805","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409177815","type":"CDM"},{"code":"00409177815","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188602","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189003","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189003","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189301","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189301","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189303","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189303","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189313","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189313","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189323","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189323","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409190201","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190201","type":"NDC"}],"standard_charges":[{"gross_charge":3257.51,"discounted_cash":2280.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409190211","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190211","type":"NDC"}],"standard_charges":[{"gross_charge":582.85,"discounted_cash":408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409196601","type":"CDM"},{"code":"00409196601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409196602","type":"CDM"},{"code":"00409196602","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409196607","type":"CDM"},{"code":"00409196607","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409196612","type":"CDM"},{"code":"00409196612","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409205001","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409205001","type":"NDC"}],"standard_charges":[{"gross_charge":46.8,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409205020","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409205020","type":"NDC"}],"standard_charges":[{"gross_charge":46.8,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205105","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205115","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205115","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409222201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409222201","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409222212","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409222212","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409226725","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409230517","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230517","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409230801","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230801","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409230802","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409230822","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230822","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230869","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230869","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409233924","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409233924","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409233934","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409263401","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409263401","type":"NDC"}],"standard_charges":[{"gross_charge":124.49,"discounted_cash":87.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409263405","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409263405","type":"NDC"}],"standard_charges":[{"gross_charge":115.99,"discounted_cash":81.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409263425","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409263425","type":"NDC"}],"standard_charges":[{"gross_charge":59.48,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409272001","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409272002","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409272031","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272031","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272330","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272330","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317716","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317716","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409318201","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409318211","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318211","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409318905","type":"CDM"},{"code":"00409318905","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409318910","type":"CDM"},{"code":"00409318910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409321312","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409321312","type":"NDC"}],"standard_charges":[{"gross_charge":45.13,"discounted_cash":31.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409329905","type":"CDM"},{"code":"00409329905","type":"NDC"}],"standard_charges":[{"gross_charge":97.78,"discounted_cash":68.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409329915","type":"CDM"},{"code":"00409329915","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330001","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330024","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":54.46,"discounted_cash":38.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409336510","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409336510","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409336511","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409336511","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341411","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341418","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341418","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341421","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341421","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379601","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379619","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379619","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409381201","type":"CDM"},{"code":"00409381201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381411","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00409381411","type":"NDC"}],"standard_charges":[{"gross_charge":44.08,"discounted_cash":30.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":156.83,"discounted_cash":109.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECT, BACTERIOSTATIC BENZYL ALCOHOL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409397701","type":"CDM"},{"code":"00409397701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":303.24,"discounted_cash":212.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":156.01,"discounted_cash":109.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409412101","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409412101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409412150","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409412150","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409420801","type":"CDM"},{"code":"00409420801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409420810","type":"CDM"},{"code":"00409420810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426411","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426411","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427616","type":"CDM"},{"code":"00409427616","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409427801","type":"CDM"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409427816","type":"CDM"},{"code":"00409427816","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427916","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427916","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409428301","type":"CDM"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409428311","type":"CDM"},{"code":"00409428311","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 4%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409428325","type":"CDM"},{"code":"00409428325","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409433201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409433201","type":"NDC"}],"standard_charges":[{"gross_charge":63.36,"discounted_cash":44.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409433211","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409433211","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409444401","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409444401","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":53.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409444424","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00409444424","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":53.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"discounted_cash":39.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":272.44,"discounted_cash":190.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":112.33,"discounted_cash":78.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475503","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475518","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475518","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409477601","type":"CDM"},{"code":"00409477601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409477610","type":"CDM"},{"code":"00409477610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477750","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477750","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477750","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477750","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488717","type":"CDM"},{"code":"00409488717","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488723","type":"CDM"},{"code":"00409488723","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488801","type":"CDM"},{"code":"00409488801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488802","type":"CDM"},{"code":"00409488802","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488803","type":"CDM"},{"code":"00409488803","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488806","type":"CDM"},{"code":"00409488806","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409493301","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409493301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00409493311","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409493311","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409553414","type":"CDM"},{"code":"00409553414","type":"NDC"}],"standard_charges":[{"gross_charge":159.26,"discounted_cash":111.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409553424","type":"CDM"},{"code":"00409553424","type":"NDC"}],"standard_charges":[{"gross_charge":144.7,"discounted_cash":101.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.26,"discounted_cash":43.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409573801","type":"CDM"},{"code":"00409573801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409573810","type":"CDM"},{"code":"00409573810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":157.77,"discounted_cash":110.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592116","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592116","type":"NDC"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592201","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":101.55,"discounted_cash":71.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":45.77,"discounted_cash":32.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610218","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610218","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610219","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610219","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409610219","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610219","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409610220","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610220","type":"NDC"}],"standard_charges":[{"gross_charge":43.41,"discounted_cash":30.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610226","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610226","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409613903","type":"CDM"},{"code":"00409613903","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":587.98,"discounted_cash":411.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERYTHROMYCIN LACTOBIONATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409648211","type":"CDM"},{"code":"J1364","type":"HCPCS"},{"code":"00409648211","type":"NDC"}],"standard_charges":[{"gross_charge":757.12,"discounted_cash":529.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653311","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653311","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653321","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653321","type":"NDC"}],"standard_charges":[{"gross_charge":128.77,"discounted_cash":90.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409656201","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"00409656201","type":"NDC"}],"standard_charges":[{"gross_charge":85.56,"discounted_cash":59.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662514","type":"CDM"},{"code":"00409662514","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662522","type":"CDM"},{"code":"00409662522","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409663714","type":"CDM"},{"code":"00409663714","type":"NDC"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":49.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409663724","type":"CDM"},{"code":"00409663724","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409664802","type":"CDM"},{"code":"00409664802","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669502","type":"CDM"},{"code":"00409669502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669512","type":"CDM"},{"code":"00409669512","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR IRRIGATION, STERILE IRRIGATION SOLN","drug_information":{"unit":1500.0,"type":"ML"},"code_information":[{"code":"Rx00409713936","type":"CDM"},{"code":"00409713936","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409729973","type":"CDM"},{"code":"00409729973","type":"NDC"}],"standard_charges":[{"gross_charge":89.98,"discounted_cash":62.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409729983","type":"CDM"},{"code":"00409729983","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733201","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733211","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733211","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733503","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733503","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733513","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733513","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx00409739172","type":"CDM"},{"code":"00409739172","type":"NDC"}],"standard_charges":[{"gross_charge":392.29,"discounted_cash":274.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx00409739182","type":"CDM"},{"code":"00409739182","type":"NDC"}],"standard_charges":[{"gross_charge":146.94,"discounted_cash":102.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751716","type":"CDM"},{"code":"00409751716","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751766","type":"CDM"},{"code":"00409751766","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409762013","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409762013","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409762049","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409762049","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409762059","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409762059","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"00409765005","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765030","type":"CDM"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765030","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765052","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765052","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765052","type":"CDM"},{"code":"00409765052","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765062","type":"CDM"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765062","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409773037","type":"CDM"},{"code":"00409773037","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409780911","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409780911","type":"NDC"}],"standard_charges":[{"gross_charge":55.31,"discounted_cash":38.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409780922","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":121.26,"discounted_cash":84.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409791819","type":"CDM"},{"code":"00409791819","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409792313","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792313","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409792336","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792336","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792903","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792903","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409793009","type":"CDM"},{"code":"00409793009","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798361","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409812601","type":"CDM"},{"code":"00409812601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":43.32,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409818311","type":"CDM"},{"code":"00409818311","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904201","type":"CDM"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904211","type":"CDM"},{"code":"00409904211","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904516","type":"CDM"},{"code":"00409904516","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909417","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909417","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909418","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909418","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909428","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909428","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909461","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909461","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":45.69,"discounted_cash":31.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409910421","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409910421","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409915731","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915731","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409915750","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915750","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THYROID TAB 15 MG (1/4 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045701","type":"CDM"},{"code":"00456045701","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.22,"discounted_cash":13.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456321011","type":"CDM"},{"code":"00456321011","type":"NDC"}],"standard_charges":[{"gross_charge":30.38,"discounted_cash":21.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456321063","type":"CDM"},{"code":"00456321063","type":"NDC"}],"standard_charges":[{"gross_charge":72.54,"discounted_cash":50.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469061773","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00469061773","type":"NDC"}],"standard_charges":[{"gross_charge":72.44,"discounted_cash":50.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRABEGRON TAB ER 24 HR 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469260130","type":"CDM"},{"code":"00469260130","type":"NDC"}],"standard_charges":[{"gross_charge":128.9,"discounted_cash":90.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2041.37,"discounted_cash":1428.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1038.35,"discounted_cash":726.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLBETUXIMAB-CLZB FOR IV SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469442530","type":"CDM"},{"code":"J1326","type":"HCPCS"},{"code":"00469442530","type":"NDC"}],"standard_charges":[{"gross_charge":29760.0,"discounted_cash":20832.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00472037915","type":"CDM"},{"code":"00472037915","type":"NDC"}],"standard_charges":[{"gross_charge":105.9,"discounted_cash":74.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00472103016","type":"CDM"},{"code":"00472103016","type":"NDC"}],"standard_charges":[{"gross_charge":17.49,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00480925908","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00480925908","type":"NDC"}],"standard_charges":[{"gross_charge":16283.78,"discounted_cash":11398.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE FOR IM INJ KIT 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00480926208","type":"CDM"},{"code":"J2353","type":"HCPCS"},{"code":"00480926208","type":"NDC"}],"standard_charges":[{"gross_charge":19498.0,"discounted_cash":13648.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM PHOSPHATE MONOBASIC TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00486111101","type":"CDM"},{"code":"00486111101","type":"NDC"}],"standard_charges":[{"gross_charge":16.76,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.41,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00487278401","type":"CDM"},{"code":"00487278401","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8.31,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00487960101","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487960101","type":"NDC"}],"standard_charges":[{"gross_charge":75.93,"discounted_cash":53.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00487960130","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487960130","type":"NDC"}],"standard_charges":[{"gross_charge":35.99,"discounted_cash":25.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML)","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00487990130","type":"CDM"},{"code":"J7611","type":"HCPCS"},{"code":"00487990130","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00496088205","type":"CDM"},{"code":"00496088205","type":"NDC"}],"standard_charges":[{"gross_charge":59.1,"discounted_cash":41.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00496088206","type":"CDM"},{"code":"00496088206","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE CREAM 4% & TRANSPARENT DRESSING KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00496088207","type":"CDM"},{"code":"00496088207","type":"NDC"}],"standard_charges":[{"gross_charge":118.98,"discounted_cash":83.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517037401","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037401","type":"NDC"}],"standard_charges":[{"gross_charge":1772.1,"discounted_cash":1240.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":858.54,"discounted_cash":600.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4479.44,"discounted_cash":3135.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4086.33,"discounted_cash":2860.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":61.44,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517073501","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00517073501","type":"NDC"}],"standard_charges":[{"gross_charge":226.31,"discounted_cash":158.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517073510","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00517073510","type":"NDC"}],"standard_charges":[{"gross_charge":223.86,"discounted_cash":156.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517074001","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"00517074001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":217.94,"discounted_cash":152.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00517100101","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00517100125","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00517100401","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00517100425","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517198001","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"00517198001","type":"NDC"}],"standard_charges":[{"gross_charge":53.46,"discounted_cash":37.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517198005","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"00517198005","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":37.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00517210201","type":"CDM"},{"code":"00517210201","type":"NDC"}],"standard_charges":[{"gross_charge":467.78,"discounted_cash":327.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00517210225","type":"CDM"},{"code":"00517210225","type":"NDC"}],"standard_charges":[{"gross_charge":84.45,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231001","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231001","type":"NDC"}],"standard_charges":[{"gross_charge":130.1,"discounted_cash":91.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":92.47,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234001","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234001","type":"NDC"}],"standard_charges":[{"gross_charge":92.47,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":92.47,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234025","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234025","type":"NDC"}],"standard_charges":[{"gross_charge":92.47,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE & SODIUM BENZOATE INJ 125-125 MG/ML (500 MG/2ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517250201","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00517250201","type":"NDC"}],"standard_charges":[{"gross_charge":165.41,"discounted_cash":115.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":329.56,"discounted_cash":230.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00517303001","type":"CDM"},{"code":"00517303001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00517430001","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"00517430001","type":"NDC"}],"standard_charges":[{"gross_charge":5783.29,"discounted_cash":4048.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517481001","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00517481001","type":"NDC"}],"standard_charges":[{"gross_charge":94.97,"discounted_cash":66.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":106.38,"discounted_cash":74.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":89.94,"discounted_cash":62.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx00517731501","type":"CDM"},{"code":"00517731501","type":"NDC"}],"standard_charges":[{"gross_charge":390.06,"discounted_cash":273.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx00517731525","type":"CDM"},{"code":"00517731525","type":"NDC"}],"standard_charges":[{"gross_charge":108.52,"discounted_cash":75.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517750401","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517750401","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517750425","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517750425","type":"NDC"}],"standard_charges":[{"gross_charge":61.98,"discounted_cash":43.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517760401","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517760401","type":"NDC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":60.74,"discounted_cash":42.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":138.18,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":246.62,"discounted_cash":172.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527131301","type":"CDM"},{"code":"00527131301","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527131801","type":"CDM"},{"code":"00527131801","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":23.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527134401","type":"CDM"},{"code":"00527134401","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527134601","type":"CDM"},{"code":"00527134601","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527163201","type":"CDM"},{"code":"00527163201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":156.78,"discounted_cash":109.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":150.01,"discounted_cash":105.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00527512578","type":"CDM"},{"code":"00527512578","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00527600480","type":"CDM"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":190.95,"discounted_cash":133.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536105429","type":"CDM"},{"code":"00536105429","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MENTHOL-METHYL SALICYLATE CREAM","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx00536110145","type":"CDM"},{"code":"00536110145","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":14.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.99,"discounted_cash":13.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8.55,"discounted_cash":5.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123201","type":"CDM"},{"code":"00536123201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE POLACRILEX LOZENGE 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123981","type":"CDM"},{"code":"00536123981","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536124701","type":"CDM"},{"code":"00536124701","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536124801","type":"CDM"},{"code":"00536124801","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536125628","type":"CDM"},{"code":"00536125628","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536127780","type":"CDM"},{"code":"00536127780","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536128636","type":"CDM"},{"code":"00536128636","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-MINERAL OIL-PETROLATUM OINT 0.25-14-74.9%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx00536128806","type":"CDM"},{"code":"00536128806","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx00536129434","type":"CDM"},{"code":"00536129434","type":"NDC"}],"standard_charges":[{"gross_charge":49.2,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx00536130375","type":"CDM"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536130840","type":"CDM"},{"code":"00536130840","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536135501","type":"CDM"},{"code":"00536135501","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536136234","type":"CDM"},{"code":"00536136234","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7.72,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536141401","type":"CDM"},{"code":"00536141401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536144540","type":"CDM"},{"code":"00536144540","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.8,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536302923","type":"CDM"},{"code":"00536302923","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536302925","type":"CDM"},{"code":"00536302925","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536333401","type":"CDM"},{"code":"00536333401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 400 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536384401","type":"CDM"},{"code":"00536384401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536430608","type":"CDM"},{"code":"00536430608","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536509008","type":"CDM"},{"code":"00536509008","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8.67,"discounted_cash":6.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9.41,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589671","type":"CDM"},{"code":"00536589671","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7.61,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00536741551","type":"CDM"},{"code":"00536741551","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536781708","type":"CDM"},{"code":"00536781708","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":261.85,"discounted_cash":183.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":160.82,"discounted_cash":112.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYALURONIDASE BOVINE INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548909010","type":"CDM"},{"code":"J3470","type":"HCPCS"},{"code":"00548909010","type":"NDC"}],"standard_charges":[{"gross_charge":327.79,"discounted_cash":229.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555015902","type":"CDM"},{"code":"00555015902","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555030202","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"00555030202","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555032302","type":"CDM"},{"code":"00555032302","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555077902","type":"CDM"},{"code":"00555077902","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROAMPHETAMINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555095202","type":"CDM"},{"code":"00555095202","type":"NDC"}],"standard_charges":[{"gross_charge":16.49,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780501","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780501","type":"NDC"}],"standard_charges":[{"gross_charge":857.9,"discounted_cash":600.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780505","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780505","type":"NDC"}],"standard_charges":[{"gross_charge":857.94,"discounted_cash":600.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 250 UNIT (50 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780600","type":"CDM"},{"code":"J2788","type":"HCPCS"},{"code":"00562780600","type":"NDC"}],"standard_charges":[{"gross_charge":310.15,"discounted_cash":217.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":360.03,"discounted_cash":252.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER SUPPOS 0.25-88.44%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573288310","type":"CDM"},{"code":"00573288310","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER SUPPOS 0.25-88.44%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00573288320","type":"CDM"},{"code":"00573288320","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8.55,"discounted_cash":5.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574006930","type":"CDM"},{"code":"00574006930","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":5.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574007015","type":"CDM"},{"code":"00574007015","type":"NDC"}],"standard_charges":[{"gross_charge":23.67,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574007030","type":"CDM"},{"code":"00574007030","type":"NDC"}],"standard_charges":[{"gross_charge":8.46,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010770","type":"CDM"},{"code":"00574010770","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574010777","type":"CDM"},{"code":"00574010777","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ORAL VEHICLES","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00574030316","type":"CDM"},{"code":"00574030316","type":"NDC"}],"standard_charges":[{"gross_charge":99.33,"discounted_cash":69.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052176","type":"CDM"},{"code":"00574052176","type":"NDC"}],"standard_charges":[{"gross_charge":64.08,"discounted_cash":44.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1051.28,"discounted_cash":735.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00574085010","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00574085010","type":"NDC"}],"standard_charges":[{"gross_charge":998.72,"discounted_cash":699.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574200815","type":"CDM"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":162.48,"discounted_cash":113.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE OPHTH SUSP 0.3-0.1%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00574403125","type":"CDM"},{"code":"00574403125","type":"NDC"}],"standard_charges":[{"gross_charge":197.3,"discounted_cash":138.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7.53,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722612","type":"CDM"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"gross_charge":76.88,"discounted_cash":53.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591024001","type":"CDM"},{"code":"00591024001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591040401","type":"CDM"},{"code":"00591040401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591079601","type":"CDM"},{"code":"00591079601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267911","type":"CDM"},{"code":"00591267911","type":"NDC"}],"standard_charges":[{"gross_charge":72.81,"discounted_cash":50.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267930","type":"CDM"},{"code":"00591267930","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":14.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBENDAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591271202","type":"CDM"},{"code":"00591271202","type":"NDC"}],"standard_charges":[{"gross_charge":123.66,"discounted_cash":86.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591288001","type":"CDM"},{"code":"00591288001","type":"NDC"}],"standard_charges":[{"gross_charge":20.73,"discounted_cash":14.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352511","type":"CDM"},{"code":"00591352511","type":"NDC"}],"standard_charges":[{"gross_charge":22.12,"discounted_cash":15.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352530","type":"CDM"},{"code":"00591352530","type":"NDC"}],"standard_charges":[{"gross_charge":20.78,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591371330","type":"CDM"},{"code":"00591371330","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387544","type":"CDM"},{"code":"00591387544","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387545","type":"CDM"},{"code":"00591387545","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591533701","type":"CDM"},{"code":"00591533701","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2343.67,"discounted_cash":1640.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL CAP 18 MCG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597007575","type":"CDM"},{"code":"00597007575","type":"NDC"}],"standard_charges":[{"gross_charge":98.47,"discounted_cash":68.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2014.36,"discounted_cash":1410.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015237","type":"CDM"},{"code":"00597015237","type":"NDC"}],"standard_charges":[{"gross_charge":88.46,"discounted_cash":61.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015337","type":"CDM"},{"code":"00597015337","type":"NDC"}],"standard_charges":[{"gross_charge":88.46,"discounted_cash":61.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22287.59,"discounted_cash":15601.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28.38,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188010","type":"CDM"},{"code":"00603188010","type":"NDC"}],"standard_charges":[{"gross_charge":22.86,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188016","type":"CDM"},{"code":"00603188016","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533821","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533821","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":12.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00641036725","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036725","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx00641047725","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047725","type":"NDC"}],"standard_charges":[{"gross_charge":117.64,"discounted_cash":82.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641092825","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641139731","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139731","type":"NDC"}],"standard_charges":[{"gross_charge":230.07,"discounted_cash":161.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":267.74,"discounted_cash":187.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139831","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139831","type":"NDC"}],"standard_charges":[{"gross_charge":60.67,"discounted_cash":42.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141031","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141031","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641149531","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641149531","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641149535","type":"CDM"},{"code":"J2550","type":"HCPCS"},{"code":"00641149535","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPYRIDAMOLE IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641256941","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00641256941","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPYRIDAMOLE IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641256944","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00641256944","type":"NDC"}],"standard_charges":[{"gross_charge":148.21,"discounted_cash":103.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600101","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600101","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600125","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600701","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600801","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600810","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00641601310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601501","type":"CDM"},{"code":"00641601501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602001","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641602001","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602010","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641602010","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602701","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00641602725","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602801","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602801","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641603001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641605301","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605301","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPERIDINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641605325","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605325","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPERIDINE HCL INJ 100 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641605401","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605401","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPERIDINE HCL INJ 100 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641605425","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605425","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641606125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607801","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607901","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641610301","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"00641610301","type":"NDC"}],"standard_charges":[{"gross_charge":55.77,"discounted_cash":39.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641610325","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"00641610325","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611610","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641612501","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612501","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641612525","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.8,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641613501","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"00641613501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641613525","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"00641613525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641613701","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00641613701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641613710","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00641613710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614901","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641614901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614910","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641615101","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641615101","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641615125","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00641615125","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00641616401","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"00641616401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617501","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617510","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641622801","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"00641622801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641622825","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"00641622825","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641623101","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"00641623101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641623125","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"00641623125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00641623601","type":"CDM"},{"code":"00641623601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00641623610","type":"CDM"},{"code":"00641623610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641624401","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00641624401","type":"NDC"}],"standard_charges":[{"gross_charge":29.09,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641624410","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":90.81,"discounted_cash":63.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.5,"type":"ML"},"code_information":[{"code":"Rx00641624701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641624701","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641624725","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641624725","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641626501","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641626501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641626510","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641626510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641921701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641921710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641921910","type":"CDM"},{"code":"00641921910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00703003101","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00703003101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703011003","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011003","type":"NDC"}],"standard_charges":[{"gross_charge":25.94,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":64.76,"discounted_cash":45.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703291401","type":"CDM"},{"code":"00703291401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703291403","type":"CDM"},{"code":"00703291403","type":"NDC"}],"standard_charges":[{"gross_charge":50.65,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00703321801","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"00703321801","type":"NDC"}],"standard_charges":[{"gross_charge":386.29,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703331101","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703331101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703331104","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703331104","type":"NDC"}],"standard_charges":[{"gross_charge":52.26,"discounted_cash":36.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703367101","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"00703367101","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703398501","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"00703398501","type":"NDC"}],"standard_charges":[{"gross_charge":585.24,"discounted_cash":409.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IDARUBICIN HCL IV INJ 20 MG/20ML (1 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00703415611","type":"CDM"},{"code":"J9211","type":"HCPCS"},{"code":"00703415611","type":"NDC"}],"standard_charges":[{"gross_charge":3509.7,"discounted_cash":2456.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":606.25,"discounted_cash":424.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703440211","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"00703440211","type":"NDC"}],"standard_charges":[{"gross_charge":173.91,"discounted_cash":121.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703441211","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"00703441211","type":"NDC"}],"standard_charges":[{"gross_charge":307.5,"discounted_cash":215.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450201","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450204","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOXANTRONE HCL INJ CONC 25 MG/12.5ML (2 MG/ML)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00703468001","type":"CDM"},{"code":"J9293","type":"HCPCS"},{"code":"00703468001","type":"NDC"}],"standard_charges":[{"gross_charge":2882.92,"discounted_cash":2018.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":170.51,"discounted_cash":119.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703507503","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"00703507503","type":"NDC"}],"standard_charges":[{"gross_charge":167.11,"discounted_cash":116.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1429.21,"discounted_cash":1000.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 50 MG/50ML (1 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00703574711","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00703574711","type":"NDC"}],"standard_charges":[{"gross_charge":164.85,"discounted_cash":115.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00703574811","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"00703574811","type":"NDC"}],"standard_charges":[{"gross_charge":306.48,"discounted_cash":214.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00703951401","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"00703951401","type":"NDC"}],"standard_charges":[{"gross_charge":58.93,"discounted_cash":41.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":111.99,"discounted_cash":78.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713010906","type":"CDM"},{"code":"00713010906","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013506","type":"CDM"},{"code":"00713013506","type":"NDC"}],"standard_charges":[{"gross_charge":64.77,"discounted_cash":45.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":80.52,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx00713026831","type":"CDM"},{"code":"00713026831","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713050306","type":"CDM"},{"code":"00713050306","type":"NDC"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":55.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":103.98,"discounted_cash":72.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30.09,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713053606","type":"CDM"},{"code":"00713053606","type":"NDC"}],"standard_charges":[{"gross_charge":37.61,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.48,"discounted_cash":24.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":149.81,"discounted_cash":104.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068315","type":"CDM"},{"code":"00713068315","type":"NDC"}],"standard_charges":[{"gross_charge":131.57,"discounted_cash":92.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":114.51,"discounted_cash":80.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00761035920","type":"CDM"},{"code":"00761035920","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781120501","type":"CDM"},{"code":"00781120501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139201","type":"CDM"},{"code":"00781139201","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139213","type":"CDM"},{"code":"00781139213","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781196260","type":"CDM"},{"code":"00781196260","type":"NDC"}],"standard_charges":[{"gross_charge":18.56,"discounted_cash":12.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781207401","type":"CDM"},{"code":"00781207401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781217660","type":"CDM"},{"code":"00781217660","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261301","type":"CDM"},{"code":"00781261301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261305","type":"CDM"},{"code":"00781261305","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781305972","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00781305972","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00781311390","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311390","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00781311395","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311395","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00781311491","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311491","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00781311495","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311495","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781315270","type":"CDM"},{"code":"00781315270","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781315295","type":"CDM"},{"code":"00781315295","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx00781315401","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":1375.9,"discounted_cash":963.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315894","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00781315894","type":"NDC"}],"standard_charges":[{"gross_charge":1009.99,"discounted_cash":706.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315895","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"00781315895","type":"NDC"}],"standard_charges":[{"gross_charge":731.69,"discounted_cash":512.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":128.48,"discounted_cash":89.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320885","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320885","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781323294","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00781323294","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781323295","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00781323295","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00781323801","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781323801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324602","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324602","type":"NDC"}],"standard_charges":[{"gross_charge":49.23,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781325394","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"00781325394","type":"NDC"}],"standard_charges":[{"gross_charge":5229.14,"discounted_cash":3660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781326805","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326805","type":"NDC"}],"standard_charges":[{"gross_charge":54.28,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781326869","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":54.28,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":67.22,"discounted_cash":47.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":66.37,"discounted_cash":46.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.69,"discounted_cash":57.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781329091","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781329091","type":"NDC"}],"standard_charges":[{"gross_charge":52.33,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.58,"discounted_cash":57.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":64.12,"discounted_cash":44.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00781329905","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329905","type":"NDC"}],"standard_charges":[{"gross_charge":80.97,"discounted_cash":56.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":83.63,"discounted_cash":58.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781335603","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781335603","type":"NDC"}],"standard_charges":[{"gross_charge":150.54,"discounted_cash":105.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340485","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340485","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340495","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340495","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340778","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340778","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340795","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340795","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00781343346","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00781343346","type":"NDC"}],"standard_charges":[{"gross_charge":352.94,"discounted_cash":247.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00781343395","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00781343395","type":"NDC"}],"standard_charges":[{"gross_charge":58.71,"discounted_cash":41.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":317.06,"discounted_cash":221.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781355510","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781355510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781355525","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781355525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00781375575","type":"CDM"},{"code":"00781375575","type":"NDC"}],"standard_charges":[{"gross_charge":53.67,"discounted_cash":37.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00781375595","type":"CDM"},{"code":"00781375595","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781518192","type":"CDM"},{"code":"00781518192","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781518492","type":"CDM"},{"code":"00781518492","type":"NDC"}],"standard_charges":[{"gross_charge":15.92,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781569031","type":"CDM"},{"code":"00781569031","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 20000000 UNIT","drug_information":{"unit":1.02,"type":"EA"},"code_information":[{"code":"Rx00781613694","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00781613694","type":"NDC"}],"standard_charges":[{"gross_charge":118.16,"discounted_cash":82.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781615752","type":"CDM"},{"code":"00781615752","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781730431","type":"CDM"},{"code":"00781730431","type":"NDC"}],"standard_charges":[{"gross_charge":119.7,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVASTIGMINE TD PATCH 24HR 4.6 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781730458","type":"CDM"},{"code":"00781730458","type":"NDC"}],"standard_charges":[{"gross_charge":118.87,"discounted_cash":83.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781808931","type":"CDM"},{"code":"00781808931","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":16.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003801","type":"CDM"},{"code":"00832003801","type":"NDC"}],"standard_charges":[{"gross_charge":16.22,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003889","type":"CDM"},{"code":"00832003889","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMANTADINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832011103","type":"CDM"},{"code":"00832011103","type":"NDC"}],"standard_charges":[{"gross_charge":22.84,"discounted_cash":15.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMANTADINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832011189","type":"CDM"},{"code":"00832011189","type":"NDC"}],"standard_charges":[{"gross_charge":21.06,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00832046515","type":"CDM"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051189","type":"CDM"},{"code":"00832051189","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051201","type":"CDM"},{"code":"00832051201","type":"NDC"}],"standard_charges":[{"gross_charge":16.83,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832051289","type":"CDM"},{"code":"00832051289","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121189","type":"CDM"},{"code":"00832121189","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121201","type":"CDM"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121289","type":"CDM"},{"code":"00832121289","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121301","type":"CDM"},{"code":"00832121301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121389","type":"CDM"},{"code":"00832121389","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121400","type":"CDM"},{"code":"00832121400","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121401","type":"CDM"},{"code":"00832121401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121489","type":"CDM"},{"code":"00832121489","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121601","type":"CDM"},{"code":"00832121601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121689","type":"CDM"},{"code":"00832121689","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832154011","type":"CDM"},{"code":"00832154011","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832154089","type":"CDM"},{"code":"00832154089","type":"NDC"}],"standard_charges":[{"gross_charge":16.35,"discounted_cash":11.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832532511","type":"CDM"},{"code":"00832532511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712301","type":"CDM"},{"code":"00832712301","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832712389","type":"CDM"},{"code":"00832712389","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043004","type":"CDM"},{"code":"00904043004","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.26,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00904073431","type":"CDM"},{"code":"00904073431","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE CHEW TAB 262 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904131546","type":"CDM"},{"code":"00904131546","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904145361","type":"CDM"},{"code":"00904145361","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904205661","type":"CDM"},{"code":"00904205661","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904250091","type":"CDM"},{"code":"00904250091","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8.49,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904282161","type":"CDM"},{"code":"00904282161","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5.8,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904404360","type":"CDM"},{"code":"00904404360","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904505359","type":"CDM"},{"code":"00904505359","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.84,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904546052","type":"CDM"},{"code":"00904546052","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 40 MG/ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904546335","type":"CDM"},{"code":"00904546335","type":"NDC"}],"standard_charges":[{"gross_charge":34.29,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904550261","type":"CDM"},{"code":"00904550261","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.95,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552987","type":"CDM"},{"code":"00904552987","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904555159","type":"CDM"},{"code":"00904555159","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904567661","type":"CDM"},{"code":"00904567661","type":"NDC"}],"standard_charges":[{"gross_charge":16.88,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904567761","type":"CDM"},{"code":"00904567761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578561","type":"CDM"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579061","type":"CDM"},{"code":"00904579061","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904582460","type":"CDM"},{"code":"00904582460","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904582461","type":"CDM"},{"code":"00904582461","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585261","type":"CDM"},{"code":"00904585261","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585361","type":"CDM"},{"code":"00904585361","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585461","type":"CDM"},{"code":"00904585461","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904588061","type":"CDM"},{"code":"00904588061","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.54,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589361","type":"CDM"},{"code":"00904589361","type":"NDC"}],"standard_charges":[{"gross_charge":16.98,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.52,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":226.0,"type":"GM"},"code_information":[{"code":"Rx00904598426","type":"CDM"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600761","type":"CDM"},{"code":"00904600761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600861","type":"CDM"},{"code":"00904600861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904601946","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904601946","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608461","type":"CDM"},{"code":"00904608461","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904615760","type":"CDM"},{"code":"00904615760","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.64,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904617861","type":"CDM"},{"code":"00904617861","type":"NDC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904626908","type":"CDM"},{"code":"00904626908","type":"NDC"}],"standard_charges":[{"gross_charge":24.58,"discounted_cash":17.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627208","type":"CDM"},{"code":"00904627208","type":"NDC"}],"standard_charges":[{"gross_charge":29.01,"discounted_cash":20.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627761","type":"CDM"},{"code":"00904627761","type":"NDC"}],"standard_charges":[{"gross_charge":15.06,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904627961","type":"CDM"},{"code":"00904627961","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628361","type":"CDM"},{"code":"00904628361","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629106","type":"CDM"},{"code":"00904629106","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629206","type":"CDM"},{"code":"00904629206","type":"NDC"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00904630521","type":"CDM"},{"code":"00904630521","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00904632078","type":"CDM"},{"code":"00904632078","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632206","type":"CDM"},{"code":"00904632206","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.94,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.76,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635761","type":"CDM"},{"code":"00904635761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635861","type":"CDM"},{"code":"00904635861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636361","type":"CDM"},{"code":"00904636361","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636445","type":"CDM"},{"code":"00904636445","type":"NDC"}],"standard_charges":[{"gross_charge":24.03,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636461","type":"CDM"},{"code":"00904636461","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904636961","type":"CDM"},{"code":"00904636961","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637361","type":"CDM"},{"code":"00904637361","type":"NDC"}],"standard_charges":[{"gross_charge":15.84,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637761","type":"CDM"},{"code":"00904637761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637861","type":"CDM"},{"code":"00904637861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904639161","type":"CDM"},{"code":"00904639161","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640861","type":"CDM"},{"code":"00904640861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641861","type":"CDM"},{"code":"00904641861","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642061","type":"CDM"},{"code":"00904642061","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904643604","type":"CDM"},{"code":"00904643604","type":"NDC"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":19.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904643961","type":"CDM"},{"code":"00904643961","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644961","type":"CDM"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645361","type":"CDM"},{"code":"00904645361","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":105.29,"discounted_cash":73.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646710","type":"CDM"},{"code":"00904646710","type":"NDC"}],"standard_charges":[{"gross_charge":61.14,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646861","type":"CDM"},{"code":"00904646861","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646961","type":"CDM"},{"code":"00904646961","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647104","type":"CDM"},{"code":"00904647104","type":"NDC"}],"standard_charges":[{"gross_charge":118.05,"discounted_cash":82.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647761","type":"CDM"},{"code":"00904647761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647861","type":"CDM"},{"code":"00904647861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904648561","type":"CDM"},{"code":"00904648561","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904648661","type":"CDM"},{"code":"00904648661","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650006","type":"CDM"},{"code":"00904650006","type":"NDC"}],"standard_charges":[{"gross_charge":19.39,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.05,"discounted_cash":14.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650261","type":"CDM"},{"code":"00904650261","type":"NDC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650361","type":"CDM"},{"code":"00904650361","type":"NDC"}],"standard_charges":[{"gross_charge":19.27,"discounted_cash":13.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650506","type":"CDM"},{"code":"00904650506","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.54,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":64.92,"discounted_cash":45.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651061","type":"CDM"},{"code":"00904651061","type":"NDC"}],"standard_charges":[{"gross_charge":38.15,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.07,"discounted_cash":10.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904654661","type":"CDM"},{"code":"00904654661","type":"NDC"}],"standard_charges":[{"gross_charge":16.98,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.05,"discounted_cash":20.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655761","type":"CDM"},{"code":"00904655761","type":"NDC"}],"standard_charges":[{"gross_charge":17.83,"discounted_cash":12.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.8,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656461","type":"CDM"},{"code":"00904656461","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.47,"discounted_cash":14.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656761","type":"CDM"},{"code":"00904656761","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657006","type":"CDM"},{"code":"00904657006","type":"NDC"}],"standard_charges":[{"gross_charge":19.93,"discounted_cash":13.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.04,"discounted_cash":14.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657261","type":"CDM"},{"code":"00904657261","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.05,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659204","type":"CDM"},{"code":"00904659204","type":"NDC"}],"standard_charges":[{"gross_charge":61.73,"discounted_cash":43.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.3,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.07,"discounted_cash":10.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661961","type":"CDM"},{"code":"00904661961","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PYRIDOSTIGMINE BROMIDE TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662261","type":"CDM"},{"code":"00904662261","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":13.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662361","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904662361","type":"NDC"}],"standard_charges":[{"gross_charge":18.26,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9.36,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663561","type":"CDM"},{"code":"00904663561","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663761","type":"CDM"},{"code":"00904663761","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666361","type":"CDM"},{"code":"00904666361","type":"NDC"}],"standard_charges":[{"gross_charge":27.62,"discounted_cash":19.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666561","type":"CDM"},{"code":"00904666561","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666661","type":"CDM"},{"code":"00904666661","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.81,"discounted_cash":11.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904668108","type":"CDM"},{"code":"00904668108","type":"NDC"}],"standard_charges":[{"gross_charge":34.79,"discounted_cash":24.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904668208","type":"CDM"},{"code":"00904668208","type":"NDC"}],"standard_charges":[{"gross_charge":34.56,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670782","type":"CDM"},{"code":"00904670782","type":"NDC"}],"standard_charges":[{"gross_charge":29.99,"discounted_cash":20.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671760","type":"CDM"},{"code":"00904671760","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671839","type":"CDM"},{"code":"00904671839","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672040","type":"CDM"},{"code":"00904672040","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672060","type":"CDM"},{"code":"00904672060","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904677361","type":"CDM"},{"code":"00904677361","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904677961","type":"CDM"},{"code":"00904677961","type":"NDC"}],"standard_charges":[{"gross_charge":19.13,"discounted_cash":13.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678504","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00904678504","type":"NDC"}],"standard_charges":[{"gross_charge":28.88,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678561","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"00904678561","type":"NDC"}],"standard_charges":[{"gross_charge":31.95,"discounted_cash":22.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679104","type":"CDM"},{"code":"00904679104","type":"NDC"}],"standard_charges":[{"gross_charge":36.6,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679430","type":"CDM"},{"code":"00904679430","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680806","type":"CDM"},{"code":"00904680806","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680861","type":"CDM"},{"code":"00904680861","type":"NDC"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681706","type":"CDM"},{"code":"00904681706","type":"NDC"}],"standard_charges":[{"gross_charge":16.44,"discounted_cash":11.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681806","type":"CDM"},{"code":"00904681806","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":11.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682207","type":"CDM"},{"code":"00904682207","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":21.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682461","type":"CDM"},{"code":"00904682461","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682561","type":"CDM"},{"code":"00904682561","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682661","type":"CDM"},{"code":"00904682661","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904682805","type":"CDM"},{"code":"00904682805","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":21.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904682892","type":"CDM"},{"code":"00904682892","type":"NDC"}],"standard_charges":[{"gross_charge":32.22,"discounted_cash":22.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904682894","type":"CDM"},{"code":"00904682894","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":21.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682960","type":"CDM"},{"code":"00904682960","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904683006","type":"CDM"},{"code":"00904683006","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.74,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904684673","type":"CDM"},{"code":"00904684673","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686061","type":"CDM"},{"code":"00904686061","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686961","type":"CDM"},{"code":"00904686961","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904687045","type":"CDM"},{"code":"00904687045","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.08,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINOCYCLINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904688806","type":"CDM"},{"code":"00904688806","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.31,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689961","type":"CDM"},{"code":"00904689961","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690061","type":"CDM"},{"code":"00904690061","type":"NDC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOMOXETINE HCL CAP 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904690804","type":"CDM"},{"code":"00904690804","type":"NDC"}],"standard_charges":[{"gross_charge":30.45,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691461","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"00904691461","type":"NDC"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":14.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692361","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00904692361","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692461","type":"CDM"},{"code":"00904692461","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692661","type":"CDM"},{"code":"00904692661","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692761","type":"CDM"},{"code":"00904692761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692861","type":"CDM"},{"code":"00904692861","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692961","type":"CDM"},{"code":"00904692961","type":"NDC"}],"standard_charges":[{"gross_charge":15.99,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693181","type":"CDM"},{"code":"00904693181","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693186","type":"CDM"},{"code":"00904693186","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693806","type":"CDM"},{"code":"00904693806","type":"NDC"}],"standard_charges":[{"gross_charge":19.33,"discounted_cash":13.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693961","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904693961","type":"NDC"}],"standard_charges":[{"gross_charge":18.26,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904694961","type":"CDM"},{"code":"00904694961","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695261","type":"CDM"},{"code":"00904695261","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695361","type":"CDM"},{"code":"00904695361","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695461","type":"CDM"},{"code":"00904695461","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695561","type":"CDM"},{"code":"00904695561","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.67,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.48,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904698761","type":"CDM"},{"code":"00904698761","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904698861","type":"CDM"},{"code":"00904698861","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":11.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699104","type":"CDM"},{"code":"00904699104","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699161","type":"CDM"},{"code":"00904699161","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699261","type":"CDM"},{"code":"00904699261","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699361","type":"CDM"},{"code":"00904699361","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700061","type":"CDM"},{"code":"00904700061","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.9,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700761","type":"CDM"},{"code":"00904700761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701604","type":"CDM"},{"code":"00904701604","type":"NDC"}],"standard_charges":[{"gross_charge":22.29,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701606","type":"CDM"},{"code":"00904701606","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":12.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.05,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702261","type":"CDM"},{"code":"00904702261","type":"NDC"}],"standard_charges":[{"gross_charge":32.83,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.78,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904703587","type":"CDM"},{"code":"00904703587","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704161","type":"CDM"},{"code":"00904704161","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704304","type":"CDM"},{"code":"00904704304","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":12.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704361","type":"CDM"},{"code":"00904704361","type":"NDC"}],"standard_charges":[{"gross_charge":19.29,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.65,"discounted_cash":13.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704606","type":"CDM"},{"code":"00904704606","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704861","type":"CDM"},{"code":"00904704861","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705261","type":"CDM"},{"code":"00904705261","type":"NDC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705361","type":"CDM"},{"code":"00904705361","type":"NDC"}],"standard_charges":[{"gross_charge":17.27,"discounted_cash":12.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705699","type":"CDM"},{"code":"00904705699","type":"NDC"}],"standard_charges":[{"gross_charge":84.46,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904706188","type":"CDM"},{"code":"00904706188","type":"NDC"}],"standard_charges":[{"gross_charge":30.2,"discounted_cash":21.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904706441","type":"CDM"},{"code":"00904706441","type":"NDC"}],"standard_charges":[{"gross_charge":134.51,"discounted_cash":94.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904706561","type":"CDM"},{"code":"00904706561","type":"NDC"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707061","type":"CDM"},{"code":"00904707061","type":"NDC"}],"standard_charges":[{"gross_charge":28.63,"discounted_cash":20.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904707341","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00904707341","type":"NDC"}],"standard_charges":[{"gross_charge":91.46,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904707393","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00904707393","type":"NDC"}],"standard_charges":[{"gross_charge":92.73,"discounted_cash":64.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707461","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00904707461","type":"NDC"}],"standard_charges":[{"gross_charge":16.03,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707561","type":"CDM"},{"code":"00904707561","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707761","type":"CDM"},{"code":"00904707761","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708361","type":"CDM"},{"code":"00904708361","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOZAPINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708761","type":"CDM"},{"code":"00904708761","type":"NDC"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.38,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904709061","type":"CDM"},{"code":"00904709061","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":13.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.83,"discounted_cash":12.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.92,"discounted_cash":14.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904709761","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904709761","type":"NDC"}],"standard_charges":[{"gross_charge":19.41,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710304","type":"CDM"},{"code":"00904710304","type":"NDC"}],"standard_charges":[{"gross_charge":70.28,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710310","type":"CDM"},{"code":"00904710310","type":"NDC"}],"standard_charges":[{"gross_charge":32.09,"discounted_cash":22.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711561","type":"CDM"},{"code":"00904711561","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711861","type":"CDM"},{"code":"00904711861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711906","type":"CDM"},{"code":"00904711906","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712004","type":"CDM"},{"code":"00904712004","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":21.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712261","type":"CDM"},{"code":"00904712261","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712461","type":"CDM"},{"code":"00904712461","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712661","type":"CDM"},{"code":"00904712661","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712761","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00904712761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.15,"discounted_cash":16.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904713006","type":"CDM"},{"code":"00904713006","type":"NDC"}],"standard_charges":[{"gross_charge":25.47,"discounted_cash":17.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714004","type":"CDM"},{"code":"00904714004","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":14.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714110","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"00904714110","type":"NDC"}],"standard_charges":[{"gross_charge":25.09,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.62,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714461","type":"CDM"},{"code":"00904714461","type":"NDC"}],"standard_charges":[{"gross_charge":79.19,"discounted_cash":55.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715361","type":"CDM"},{"code":"00904715361","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715404","type":"CDM"},{"code":"00904715404","type":"NDC"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715504","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00904715504","type":"NDC"}],"standard_charges":[{"gross_charge":29.93,"discounted_cash":20.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715661","type":"CDM"},{"code":"00904715661","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716261","type":"CDM"},{"code":"00904716261","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716361","type":"CDM"},{"code":"00904716361","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716461","type":"CDM"},{"code":"00904716461","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717207","type":"CDM"},{"code":"00904717207","type":"NDC"}],"standard_charges":[{"gross_charge":21.82,"discounted_cash":15.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717761","type":"CDM"},{"code":"00904717761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717861","type":"CDM"},{"code":"00904717861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717961","type":"CDM"},{"code":"00904717961","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718461","type":"CDM"},{"code":"00904718461","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718761","type":"CDM"},{"code":"00904718761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718861","type":"CDM"},{"code":"00904718861","type":"NDC"}],"standard_charges":[{"gross_charge":21.34,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719106","type":"CDM"},{"code":"00904719106","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719361","type":"CDM"},{"code":"00904719361","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719907","type":"CDM"},{"code":"00904719907","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":13.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720806","type":"CDM"},{"code":"00904720806","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720861","type":"CDM"},{"code":"00904720861","type":"NDC"}],"standard_charges":[{"gross_charge":18.44,"discounted_cash":12.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721761","type":"CDM"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721861","type":"CDM"},{"code":"00904721861","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721961","type":"CDM"},{"code":"00904721961","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722461","type":"CDM"},{"code":"00904722461","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722761","type":"CDM"},{"code":"00904722761","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722961","type":"CDM"},{"code":"00904722961","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723961","type":"CDM"},{"code":"00904723961","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724468","type":"CDM"},{"code":"00904724468","type":"NDC"}],"standard_charges":[{"gross_charge":19.09,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724568","type":"CDM"},{"code":"00904724568","type":"NDC"}],"standard_charges":[{"gross_charge":23.43,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904725261","type":"CDM"},{"code":"00904725261","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904725761","type":"CDM"},{"code":"00904725761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726161","type":"CDM"},{"code":"00904726161","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726261","type":"CDM"},{"code":"00904726261","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726661","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00904726661","type":"NDC"}],"standard_charges":[{"gross_charge":18.46,"discounted_cash":12.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726761","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00904726761","type":"NDC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904727061","type":"CDM"},{"code":"00904727061","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727641","type":"CDM"},{"code":"00904727641","type":"NDC"}],"standard_charges":[{"gross_charge":17.27,"discounted_cash":12.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727670","type":"CDM"},{"code":"00904727670","type":"NDC"}],"standard_charges":[{"gross_charge":19.97,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727692","type":"CDM"},{"code":"00904727692","type":"NDC"}],"standard_charges":[{"gross_charge":20.02,"discounted_cash":14.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727966","type":"CDM"},{"code":"00904727966","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727972","type":"CDM"},{"code":"00904727972","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728306","type":"CDM"},{"code":"00904728306","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728961","type":"CDM"},{"code":"00904728961","type":"NDC"}],"standard_charges":[{"gross_charge":15.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904729261","type":"CDM"},{"code":"00904729261","type":"NDC"}],"standard_charges":[{"gross_charge":15.51,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904729361","type":"CDM"},{"code":"00904729361","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730461","type":"CDM"},{"code":"00904730461","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730561","type":"CDM"},{"code":"00904730561","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730661","type":"CDM"},{"code":"00904730661","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730761","type":"CDM"},{"code":"00904730761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904731561","type":"CDM"},{"code":"00904731561","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904731680","type":"CDM"},{"code":"00904731680","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904731688","type":"CDM"},{"code":"00904731688","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904731706","type":"CDM"},{"code":"00904731706","type":"NDC"}],"standard_charges":[{"gross_charge":16.28,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00904732103","type":"CDM"},{"code":"00904732103","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00904732176","type":"CDM"},{"code":"00904732176","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732562","type":"CDM"},{"code":"00904732562","type":"NDC"}],"standard_charges":[{"gross_charge":56.04,"discounted_cash":39.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732573","type":"CDM"},{"code":"00904732573","type":"NDC"}],"standard_charges":[{"gross_charge":56.04,"discounted_cash":39.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOLAZONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904732961","type":"CDM"},{"code":"00904732961","type":"NDC"}],"standard_charges":[{"gross_charge":27.21,"discounted_cash":19.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733661","type":"CDM"},{"code":"00904733661","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733706","type":"CDM"},{"code":"00904733706","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733735","type":"CDM"},{"code":"00904733735","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904734561","type":"CDM"},{"code":"00904734561","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904734661","type":"CDM"},{"code":"00904734661","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904735006","type":"CDM"},{"code":"00904735006","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904735061","type":"CDM"},{"code":"00904735061","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736061","type":"CDM"},{"code":"00904736061","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736161","type":"CDM"},{"code":"00904736161","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736261","type":"CDM"},{"code":"00904736261","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736706","type":"CDM"},{"code":"00904736706","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904737661","type":"CDM"},{"code":"00904737661","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738206","type":"CDM"},{"code":"00904738206","type":"NDC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":14.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738361","type":"CDM"},{"code":"00904738361","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904739061","type":"CDM"},{"code":"00904739061","type":"NDC"}],"standard_charges":[{"gross_charge":15.62,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904740361","type":"CDM"},{"code":"00904740361","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741061","type":"CDM"},{"code":"00904741061","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741761","type":"CDM"},{"code":"00904741761","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14.2,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904743535","type":"CDM"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744061","type":"CDM"},{"code":"00904744061","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744261","type":"CDM"},{"code":"00904744261","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744761","type":"CDM"},{"code":"00904744761","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744861","type":"CDM"},{"code":"00904744861","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904745161","type":"CDM"},{"code":"00904745161","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904745861","type":"CDM"},{"code":"00904745861","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904745925","type":"CDM"},{"code":"00904745925","type":"NDC"}],"standard_charges":[{"gross_charge":128.43,"discounted_cash":89.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904745941","type":"CDM"},{"code":"00904745941","type":"NDC"}],"standard_charges":[{"gross_charge":125.87,"discounted_cash":88.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904747261","type":"CDM"},{"code":"00904747261","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904747835","type":"CDM"},{"code":"00904747835","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904749661","type":"CDM"},{"code":"00904749661","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750161","type":"CDM"},{"code":"00904750161","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750504","type":"CDM"},{"code":"00904750504","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750930","type":"CDM"},{"code":"00904750930","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904751061","type":"CDM"},{"code":"00904751061","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904751366","type":"CDM"},{"code":"00904751366","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904751372","type":"CDM"},{"code":"00904751372","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904752208","type":"CDM"},{"code":"00904752208","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904752308","type":"CDM"},{"code":"00904752308","type":"NDC"}],"standard_charges":[{"gross_charge":31.69,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904755762","type":"CDM"},{"code":"00904755762","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904755773","type":"CDM"},{"code":"00904755773","type":"NDC"}],"standard_charges":[{"gross_charge":5.64,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904759182","type":"CDM"},{"code":"00904759182","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904772861","type":"CDM"},{"code":"00904772861","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00904773445","type":"CDM"},{"code":"00904773445","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCROSE 24 % ORAL SOLUTION","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00906990441","type":"CDM"},{"code":"00906990441","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx00942950410","type":"CDM"},{"code":"00942950410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":328.77,"discounted_cash":230.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944049302","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":328.77,"discounted_cash":230.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00944049505","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"00944049505","type":"NDC"}],"standard_charges":[{"gross_charge":329.84,"discounted_cash":230.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00944049506","type":"CDM"},{"code":"P9045","type":"HCPCS"},{"code":"00944049506","type":"NDC"}],"standard_charges":[{"gross_charge":321.86,"discounted_cash":225.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944265603","type":"CDM"},{"code":"J1566","type":"HCPCS"},{"code":"00944265603","type":"NDC"}],"standard_charges":[{"gross_charge":4627.21,"discounted_cash":3239.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944265707","type":"CDM"},{"code":"J1566","type":"HCPCS"},{"code":"00944265707","type":"NDC"}],"standard_charges":[{"gross_charge":3934.74,"discounted_cash":2754.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944265804","type":"CDM"},{"code":"J1566","type":"HCPCS"},{"code":"00944265804","type":"NDC"}],"standard_charges":[{"gross_charge":6573.84,"discounted_cash":4601.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV FOR SOLN 10 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944265908","type":"CDM"},{"code":"J1566","type":"HCPCS"},{"code":"00944265908","type":"NDC"}],"standard_charges":[{"gross_charge":6573.84,"discounted_cash":4601.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3127.52,"discounted_cash":2189.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4427.97,"discounted_cash":3099.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6290.87,"discounted_cash":4403.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9436.3,"discounted_cash":6605.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944270010","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270010","type":"NDC"}],"standard_charges":[{"gross_charge":3127.52,"discounted_cash":2189.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00944270011","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270011","type":"NDC"}],"standard_charges":[{"gross_charge":4431.06,"discounted_cash":3101.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00944270012","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270012","type":"NDC"}],"standard_charges":[{"gross_charge":6290.87,"discounted_cash":4403.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 30 GM/300ML","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00944270013","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270013","type":"NDC"}],"standard_charges":[{"gross_charge":9442.89,"discounted_cash":6610.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR RECOMB (RFVIII) FOR INJ 1241-1800 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944284410","type":"CDM"},{"code":"J7192","type":"HCPCS"},{"code":"00944284410","type":"NDC"}],"standard_charges":[{"gross_charge":7647.38,"discounted_cash":5353.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGASPARGASE INJ 750 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00944381001","type":"CDM"},{"code":"J9266","type":"HCPCS"},{"code":"00944381001","type":"NDC"}],"standard_charges":[{"gross_charge":114751.89,"discounted_cash":80326.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR (HUMAN) FOR INJ 1000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944394402","type":"CDM"},{"code":"J7190","type":"HCPCS"},{"code":"00944394402","type":"NDC"}],"standard_charges":[{"gross_charge":3678.11,"discounted_cash":2574.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR (HUMAN) FOR INJ 1700 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00944394602","type":"CDM"},{"code":"J7190","type":"HCPCS"},{"code":"00944394602","type":"NDC"}],"standard_charges":[{"gross_charge":6982.03,"discounted_cash":4887.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00990707714","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00990707714","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00990771503","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00990771503","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00990771513","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00990771513","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 70%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990791819","type":"CDM"},{"code":"00990791819","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 40%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00990793719","type":"CDM"},{"code":"00990793719","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00990798423","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00990798423","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx01490003956","type":"CDM"},{"code":"01490003956","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx03215012020","type":"CDM"},{"code":"03215012020","type":"NDC"}],"standard_charges":[{"gross_charge":9.68,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":192.0,"type":"ML"},"code_information":[{"code":"Rx03380000137","type":"CDM"},{"code":"03380000137","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx07610016840","type":"CDM"},{"code":"07610016840","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx07610017840","type":"CDM"},{"code":"07610017840","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 5.5 MG/0.55ML","drug_information":{"unit":0.55,"type":"ML"},"code_information":[{"code":"Rx08065183055","type":"CDM"},{"code":"08065183055","type":"NDC"}],"standard_charges":[{"gross_charge":433.89,"discounted_cash":303.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 8.5 MG/0.85ML","drug_information":{"unit":0.85,"type":"ML"},"code_information":[{"code":"Rx08065183085","type":"CDM"},{"code":"08065183085","type":"NDC"}],"standard_charges":[{"gross_charge":645.09,"discounted_cash":451.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NA HYALURON & NA HYALURON-NA CHONDROIT SUL OP KIT 0.55-0.5ML","drug_information":{"unit":1.05,"type":"ML"},"code_information":[{"code":"Rx08065183150","type":"CDM"},{"code":"08065183150","type":"NDC"}],"standard_charges":[{"gross_charge":874.92,"discounted_cash":612.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 10 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx08290306414","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"08290306414","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx08290306424","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"08290306424","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070028","type":"CDM"},{"code":"10006070028","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006073051","type":"CDM"},{"code":"10006073051","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":521.16,"discounted_cash":364.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019055304","type":"CDM"},{"code":"10019055304","type":"NDC"}],"standard_charges":[{"gross_charge":114.17,"discounted_cash":79.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019055390","type":"CDM"},{"code":"10019055390","type":"NDC"}],"standard_charges":[{"gross_charge":140.88,"discounted_cash":98.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092501","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092501","type":"NDC"}],"standard_charges":[{"gross_charge":430.22,"discounted_cash":301.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IFOSFAMIDE FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10019092582","type":"CDM"},{"code":"J9208","type":"HCPCS"},{"code":"10019092582","type":"NDC"}],"standard_charges":[{"gross_charge":340.06,"discounted_cash":238.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1259.12,"discounted_cash":881.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10019095301","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":292.68,"discounted_cash":204.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx10019095362","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"10019095362","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx10119002239","type":"CDM"},{"code":"10119002239","type":"NDC"}],"standard_charges":[{"gross_charge":57.24,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PORACTANT ALFA INTRATRACHEAL SUSP 240 MG/3ML,PORACTANT ALFA INTRATRACHEAL SUSP 120 MG/1.5ML","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx10122051001","type":"CDM"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"gross_charge":3387.19,"discounted_cash":2371.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PORACTANT ALFA INTRATRACHEAL SUSP 240 MG/3ML,PORACTANT ALFA INTRATRACHEAL SUSP 120 MG/1.5ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx10122051003","type":"CDM"},{"code":"10122051003","type":"NDC"}],"standard_charges":[{"gross_charge":4682.72,"discounted_cash":3277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4310.85,"discounted_cash":3017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CANGRELOR TETRASODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10122062010","type":"CDM"},{"code":"C9460","type":"HCPCS"},{"code":"10122062010","type":"NDC"}],"standard_charges":[{"gross_charge":4021.96,"discounted_cash":2815.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOD BICARB-CITRIC ACID-SIMETH GRAN PACK 2.21-1.53-0.04 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10361079301","type":"CDM"},{"code":"10361079301","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10542001010","type":"CDM"},{"code":"10542001010","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702001001","type":"CDM"},{"code":"10702001001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702001801","type":"CDM"},{"code":"10702001801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM POLYSTYRENE SULFONATE POWDER","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx10702003645","type":"CDM"},{"code":"10702003645","type":"NDC"}],"standard_charges":[{"gross_charge":560.59,"discounted_cash":392.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOVE OIL","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx10742000091","type":"CDM"},{"code":"10742000091","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11534016501","type":"CDM"},{"code":"11534016501","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":142.0,"type":"GM"},"code_information":[{"code":"Rx11701004514","type":"CDM"},{"code":"11701004514","type":"NDC"}],"standard_charges":[{"gross_charge":65.6,"discounted_cash":45.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11788000901","type":"CDM"},{"code":"11788000901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI IV FOR SOLN KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11994000120","type":"CDM"},{"code":"A9500","type":"HCPCS"},{"code":"11994000120","type":"NDC"}],"standard_charges":[{"gross_charge":133.72,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERFLUTREN LIPID MICROSPHERE IV SUSP 6.52 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx11994001104","type":"CDM"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":319.5,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERFLUTREN LIPID MICROSPHERE IV SUSP 6.52 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx11994001116","type":"CDM"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001116","type":"NDC"}],"standard_charges":[{"gross_charge":319.5,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.11,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":82.78,"discounted_cash":57.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12496120803","type":"CDM"},{"code":"12496120803","type":"NDC"}],"standard_charges":[{"gross_charge":82.18,"discounted_cash":57.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TETRAHYDROZOLINE HCL OPHTH SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx12547049380","type":"CDM"},{"code":"12547049380","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":18.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.82,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107000130","type":"CDM"},{"code":"13107000130","type":"NDC"}],"standard_charges":[{"gross_charge":17.13,"discounted_cash":11.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107002001","type":"CDM"},{"code":"13107002001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107003134","type":"CDM"},{"code":"13107003134","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107007001","type":"CDM"},{"code":"13107007001","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13107008401","type":"CDM"},{"code":"13107008401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3893.75,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx13533031810","type":"CDM"},{"code":"90375","type":"HCPCS"},{"code":"13533031810","type":"NDC"}],"standard_charges":[{"gross_charge":3893.75,"discounted_cash":2725.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx13533033504","type":"CDM"},{"code":"J1460","type":"HCPCS"},{"code":"13533033504","type":"NDC"}],"standard_charges":[{"gross_charge":1031.33,"discounted_cash":721.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IM SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx13533033512","type":"CDM"},{"code":"J1460","type":"HCPCS"},{"code":"13533033512","type":"NDC"}],"standard_charges":[{"gross_charge":3922.65,"discounted_cash":2745.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":787.36,"discounted_cash":551.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3229.29,"discounted_cash":2260.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063420","type":"CDM"},{"code":"J1670","type":"HCPCS"},{"code":"13533063420","type":"NDC"}],"standard_charges":[{"gross_charge":3909.81,"discounted_cash":2736.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPATITIS B IMMUN GLOB (HUMAN) IM SOLN PREF SYR 110 UT/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx13533063603","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063603","type":"NDC"}],"standard_charges":[{"gross_charge":821.51,"discounted_cash":575.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4121.13,"discounted_cash":2884.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 250 UNIT (50 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533066106","type":"CDM"},{"code":"J2788","type":"HCPCS"},{"code":"13533066106","type":"NDC"}],"standard_charges":[{"gross_charge":256.47,"discounted_cash":179.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 250 UNIT (50 MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533066160","type":"CDM"},{"code":"J2788","type":"HCPCS"},{"code":"13533066160","type":"NDC"}],"standard_charges":[{"gross_charge":244.26,"discounted_cash":170.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2841.17,"discounted_cash":1988.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx13533080021","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080021","type":"NDC"}],"standard_charges":[{"gross_charge":2841.17,"discounted_cash":1988.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":5714.9,"discounted_cash":4000.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx13533080025","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080025","type":"NDC"}],"standard_charges":[{"gross_charge":5714.9,"discounted_cash":4000.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11429.8,"discounted_cash":8000.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx13533080041","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080041","type":"NDC"}],"standard_charges":[{"gross_charge":11429.8,"discounted_cash":8000.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4022.56,"discounted_cash":2815.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx13533080072","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080072","type":"NDC"}],"standard_charges":[{"gross_charge":4161.61,"discounted_cash":2913.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668000701","type":"CDM"},{"code":"13668000701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668008130","type":"CDM"},{"code":"13668008130","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668060601","type":"CDM"},{"code":"13668060601","type":"NDC"}],"standard_charges":[{"gross_charge":25.24,"discounted_cash":17.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668060630","type":"CDM"},{"code":"13668060630","type":"NDC"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 5 MG/5ML (BASE EQUIV)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx13925016604","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"13925016604","type":"NDC"}],"standard_charges":[{"gross_charge":77.35,"discounted_cash":54.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx14539067501","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"14539067501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx14789001202","type":"CDM"},{"code":"14789001202","type":"NDC"}],"standard_charges":[{"gross_charge":682.66,"discounted_cash":477.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx14789010705","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010705","type":"NDC"}],"standard_charges":[{"gross_charge":224.97,"discounted_cash":157.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 20 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx14789010708","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010708","type":"NDC"}],"standard_charges":[{"gross_charge":70.2,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789010910","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":331.27,"discounted_cash":231.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789010916","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010916","type":"NDC"}],"standard_charges":[{"gross_charge":331.27,"discounted_cash":231.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx14789011905","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"14789011905","type":"NDC"}],"standard_charges":[{"gross_charge":550.19,"discounted_cash":385.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx14789011907","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"14789011907","type":"NDC"}],"standard_charges":[{"gross_charge":721.17,"discounted_cash":504.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx14789025007","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"14789025007","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRINOTECAN HCL LIPOSOME IV SUSP 43 MG/10ML (4.3 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx15054004301","type":"CDM"},{"code":"J9205","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":18833.98,"discounted_cash":13183.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LANREOTIDE ACETATE EXTENDED RELEASE INJ 60 MG/0.2ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx15054106003","type":"CDM"},{"code":"J1930","type":"HCPCS"},{"code":"15054106003","type":"NDC"}],"standard_charges":[{"gross_charge":22266.08,"discounted_cash":15586.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LANREOTIDE ACETATE EXTENDED RELEASE INJ 120 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx15054112004","type":"CDM"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":43435.88,"discounted_cash":30405.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN CHEW TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16500008619","type":"CDM"},{"code":"16500008619","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLTERODINE TARTRATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571012706","type":"CDM"},{"code":"16571012706","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx16571012815","type":"CDM"},{"code":"16571012815","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx16571012852","type":"CDM"},{"code":"16571012852","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOFENAC SODIUM TAB DELAYED RELEASE 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571020310","type":"CDM"},{"code":"16571020310","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067301","type":"CDM"},{"code":"16571067301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067621","type":"CDM"},{"code":"16571067621","type":"NDC"}],"standard_charges":[{"gross_charge":21.69,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571073521","type":"CDM"},{"code":"16571073521","type":"NDC"}],"standard_charges":[{"gross_charge":116.14,"discounted_cash":81.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOMYCIN-BACITRAC ZN-POLYMYX 5(3.5)MG-400UNT-10000UNT OP OIN","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx16571075453","type":"CDM"},{"code":"16571075453","type":"NDC"}],"standard_charges":[{"gross_charge":178.36,"discounted_cash":124.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571077301","type":"CDM"},{"code":"16571077301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000101","type":"CDM"},{"code":"16729000101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002010","type":"CDM"},{"code":"16729002010","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.57,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729003510","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"16729003510","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009401","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729009401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx16729011408","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":423.32,"discounted_cash":296.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729011505","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729011505","type":"NDC"}],"standard_charges":[{"gross_charge":746.91,"discounted_cash":522.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729011638","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"16729011638","type":"NDC"}],"standard_charges":[{"gross_charge":9330.59,"discounted_cash":6531.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018201","type":"CDM"},{"code":"16729018201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020001","type":"CDM"},{"code":"16729020001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021101","type":"CDM"},{"code":"16729021101","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729021815","type":"CDM"},{"code":"16729021815","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":575.03,"discounted_cash":402.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOPOTECAN HCL INJ 4 MG/4ML (BASE EQUIV) (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx16729024331","type":"CDM"},{"code":"J9351","type":"HCPCS"},{"code":"16729024331","type":"NDC"}],"standard_charges":[{"gross_charge":547.47,"discounted_cash":383.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729026129","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"16729026129","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRASUGREL HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729027210","type":"CDM"},{"code":"16729027210","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRASUGREL HCL TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729027310","type":"CDM"},{"code":"16729027310","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx16729027611","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"16729027611","type":"NDC"}],"standard_charges":[{"gross_charge":347.34,"discounted_cash":243.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729027730","type":"CDM"},{"code":"J9260","type":"HCPCS"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx16729028838","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":298.81,"discounted_cash":209.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx16729029805","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"16729029805","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729030610","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":387.69,"discounted_cash":271.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LURASIDONE HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729034710","type":"CDM"},{"code":"16729034710","type":"NDC"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":13.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729048501","type":"CDM"},{"code":"16729048501","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729049012","type":"CDM"},{"code":"16729049012","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx16729052608","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx16729052663","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"16729052663","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16837087290","type":"CDM"},{"code":"16837087290","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":30.09,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090011","type":"CDM"},{"code":"17238090011","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090030","type":"CDM"},{"code":"17238090030","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17238090099","type":"CDM"},{"code":"17238090099","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":380.72,"discounted_cash":266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":370.67,"discounted_cash":259.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478079201","type":"CDM"},{"code":"17478079201","type":"NDC"}],"standard_charges":[{"gross_charge":208.98,"discounted_cash":146.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx17478093415","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"17478093415","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx17478093725","type":"CDM"},{"code":"17478093725","type":"NDC"}],"standard_charges":[{"gross_charge":87.91,"discounted_cash":61.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093726","type":"CDM"},{"code":"17478093726","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003300","type":"CDM"},{"code":"20555003300","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003600","type":"CDM"},{"code":"20555003600","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003601","type":"CDM"},{"code":"20555003601","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx21922001605","type":"CDM"},{"code":"21922001605","type":"NDC"}],"standard_charges":[{"gross_charge":84.11,"discounted_cash":58.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx21922002107","type":"CDM"},{"code":"21922002107","type":"NDC"}],"standard_charges":[{"gross_charge":207.4,"discounted_cash":145.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922006204","type":"CDM"},{"code":"21922006204","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23074080320","type":"CDM"},{"code":"23074080320","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.29,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155004801","type":"CDM"},{"code":"23155004801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155005901","type":"CDM"},{"code":"23155005901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155007001","type":"CDM"},{"code":"23155007001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011801","type":"CDM"},{"code":"23155011801","type":"NDC"}],"standard_charges":[{"gross_charge":15.49,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155019401","type":"CDM"},{"code":"23155019401","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":11.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155024609","type":"CDM"},{"code":"23155024609","type":"NDC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029031","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029031","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155029032","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029032","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 500 MG/2ML (250 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029041","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155029042","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029431","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029431","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029441","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029441","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155031331","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155047332","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047332","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155047342","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155048901","type":"CDM"},{"code":"23155048901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050101","type":"CDM"},{"code":"23155050101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155051211","type":"CDM"},{"code":"23155051211","type":"NDC"}],"standard_charges":[{"gross_charge":19.61,"discounted_cash":13.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155051230","type":"CDM"},{"code":"23155051230","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx23155051841","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"23155051841","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155051901","type":"CDM"},{"code":"23155051901","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155054731","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155054731","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155054742","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155054931","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"23155054931","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.93,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PALMITATE HCL FOR SOLN 75 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx23155060351","type":"CDM"},{"code":"23155060351","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":13.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"Rx23155062031","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062031","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155062031","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062031","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"Rx23155062041","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062041","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155062041","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062041","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155066201","type":"CDM"},{"code":"23155066201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENALAPRIL MALEATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155070501","type":"CDM"},{"code":"23155070501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155073701","type":"CDM"},{"code":"23155073701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155073710","type":"CDM"},{"code":"23155073710","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155076401","type":"CDM"},{"code":"23155076401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083301","type":"CDM"},{"code":"23155083301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083711","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"23155083711","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155083730","type":"CDM"},{"code":"J7515","type":"HCPCS"},{"code":"23155083730","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085825","type":"CDM"},{"code":"23155085825","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":16.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085878","type":"CDM"},{"code":"23155085878","type":"NDC"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 250 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085978","type":"CDM"},{"code":"23155085978","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155087201","type":"CDM"},{"code":"23155087201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx23155088431","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"23155088431","type":"NDC"}],"standard_charges":[{"gross_charge":541.44,"discounted_cash":379.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx23900001252","type":"CDM"},{"code":"23900001252","type":"NDC"}],"standard_charges":[{"gross_charge":36.63,"discounted_cash":25.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx24201011001","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"24201011001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx24201011024","type":"CDM"},{"code":"J0131","type":"HCPCS"},{"code":"24201011024","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 3%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201020101","type":"CDM"},{"code":"24201020101","type":"NDC"}],"standard_charges":[{"gross_charge":680.49,"discounted_cash":476.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":682.68,"discounted_cash":477.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24201040002","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"24201040002","type":"NDC"}],"standard_charges":[{"gross_charge":3116.57,"discounted_cash":2181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208041105","type":"CDM"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":155.16,"discounted_cash":108.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208043405","type":"CDM"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"gross_charge":214.05,"discounted_cash":149.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":90.08,"discounted_cash":63.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048510","type":"CDM"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"gross_charge":278.8,"discounted_cash":195.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCHOLINE CHLORIDE INTRAOCULAR FOR SOLN 20 MG (1:100)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24208053920","type":"CDM"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":365.86,"discounted_cash":256.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208055555","type":"CDM"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":186.02,"discounted_cash":130.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208058060","type":"CDM"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":292.91,"discounted_cash":205.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":392.04,"discounted_cash":274.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":353.77,"discounted_cash":247.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208072002","type":"CDM"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":385.25,"discounted_cash":269.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208073006","type":"CDM"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":287.75,"discounted_cash":201.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":412.59,"discounted_cash":288.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208079535","type":"CDM"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":148.06,"discounted_cash":103.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":82.53,"discounted_cash":57.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010203","type":"CDM"},{"code":"24338010203","type":"NDC"}],"standard_charges":[{"gross_charge":62.58,"discounted_cash":43.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":77.28,"discounted_cash":54.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx24357070105","type":"CDM"},{"code":"24357070105","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE CREAM 4%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx24357070106","type":"CDM"},{"code":"24357070106","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24979002607","type":"CDM"},{"code":"24979002607","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010010","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"25021010010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":57.07,"discounted_cash":39.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":48.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":139.56,"discounted_cash":97.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":338.49,"discounted_cash":236.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021011482","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021011482","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011502","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012250","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021013182","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021013281","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx25021013282","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx25021013283","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013283","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014202","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014202","type":"NDC"}],"standard_charges":[{"gross_charge":44.17,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014220","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014220","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 15 (10-5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014499","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014499","type":"NDC"}],"standard_charges":[{"gross_charge":234.08,"discounted_cash":163.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015010","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021015010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015320","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"25021015320","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":141.46,"discounted_cash":99.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021017416","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"25021017416","type":"NDC"}],"standard_charges":[{"gross_charge":167.36,"discounted_cash":117.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018466","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018466","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":125.94,"discounted_cash":88.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":62.97,"discounted_cash":44.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019010","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019010","type":"NDC"}],"standard_charges":[{"gross_charge":108.13,"discounted_cash":75.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019011","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019011","type":"NDC"}],"standard_charges":[{"gross_charge":108.11,"discounted_cash":75.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019110","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019110","type":"NDC"}],"standard_charges":[{"gross_charge":233.54,"discounted_cash":163.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021019282","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021019282","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021019287","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019920","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"25021019920","type":"NDC"}],"standard_charges":[{"gross_charge":86.04,"discounted_cash":60.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESNA INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021020110","type":"CDM"},{"code":"J9209","type":"HCPCS"},{"code":"25021020110","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VINORELBINE TARTRATE INJ 10 MG/ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021020401","type":"CDM"},{"code":"J9390","type":"HCPCS"},{"code":"25021020401","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":333.68,"discounted_cash":233.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021020751","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"25021020751","type":"NDC"}],"standard_charges":[{"gross_charge":293.71,"discounted_cash":205.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021021598","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021021920","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"25021021920","type":"NDC"}],"standard_charges":[{"gross_charge":435.96,"discounted_cash":305.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021023310","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":141.05,"discounted_cash":98.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021023550","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"25021023550","type":"NDC"}],"standard_charges":[{"gross_charge":171.3,"discounted_cash":119.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx25021023926","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"25021023926","type":"NDC"}],"standard_charges":[{"gross_charge":183.85,"discounted_cash":128.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021025020","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"25021025020","type":"NDC"}],"standard_charges":[{"gross_charge":643.73,"discounted_cash":450.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021025351","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"25021025351","type":"NDC"}],"standard_charges":[{"gross_charge":160.88,"discounted_cash":112.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx25021025416","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"25021025416","type":"NDC"}],"standard_charges":[{"gross_charge":866.11,"discounted_cash":606.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021025550","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"25021025550","type":"NDC"}],"standard_charges":[{"gross_charge":437.37,"discounted_cash":306.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx25021030305","type":"CDM"},{"code":"25021030305","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021030520","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"25021030520","type":"NDC"}],"standard_charges":[{"gross_charge":308.24,"discounted_cash":215.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLOROTHIAZIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021030566","type":"CDM"},{"code":"J1205","type":"HCPCS"},{"code":"25021030566","type":"NDC"}],"standard_charges":[{"gross_charge":308.24,"discounted_cash":215.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx25021030884","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":624.36,"discounted_cash":437.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031102","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031110","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 40 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021031387","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"25021031387","type":"NDC"}],"standard_charges":[{"gross_charge":93.61,"discounted_cash":65.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021031604","type":"CDM"},{"code":"25021031604","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031905","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031925","type":"CDM"},{"code":"25021031925","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021032104","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"25021032104","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx25021032405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021032405","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040001","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040102","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040102","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx25021041078","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"25021041078","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx25021041171","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"25021041171","type":"NDC"}],"standard_charges":[{"gross_charge":72.47,"discounted_cash":50.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx25021041510","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"25021041510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":22.74,"discounted_cash":15.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 50 MCG/ML (0.05 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021046301","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"25021046301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021046810","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"25021046810","type":"NDC"}],"standard_charges":[{"gross_charge":555.4,"discounted_cash":388.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021050002","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE CITRATE INJ 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx25021060103","type":"CDM"},{"code":"J0706","type":"HCPCS"},{"code":"25021060103","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE CITRATE ORAL SOLN 60 MG/3ML (10 MG/ML BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx25021060203","type":"CDM"},{"code":"25021060203","type":"NDC"}],"standard_charges":[{"gross_charge":34.37,"discounted_cash":24.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021061551","type":"CDM"},{"code":"25021061551","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":64.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021068220","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021068220","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx25021068310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021068310","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021079002","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021079601","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"25021079601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021079810","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"25021079810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25021081230","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"25021081230","type":"NDC"}],"standard_charges":[{"gross_charge":166.8,"discounted_cash":116.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021081630","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":131.88,"discounted_cash":92.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":47.65,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 4 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082682","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":236.32,"discounted_cash":165.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021083082","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"25021083082","type":"NDC"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021083805","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"25021083805","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":28492.76,"discounted_cash":19944.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VORICONAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241006303","type":"CDM"},{"code":"27241006303","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SILODOSIN CAP 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241014401","type":"CDM"},{"code":"27241014401","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27241015504","type":"CDM"},{"code":"27241015504","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx27808000201","type":"CDM"},{"code":"27808000201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx27808006502","type":"CDM"},{"code":"27808006502","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300011201","type":"CDM"},{"code":"29300011201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300011416","type":"CDM"},{"code":"29300011416","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300012801","type":"CDM"},{"code":"29300012801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300022601","type":"CDM"},{"code":"29300022601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300022701","type":"CDM"},{"code":"29300022701","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300035916","type":"CDM"},{"code":"29300035916","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":326809.75,"discounted_cash":228766.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx30768003268","type":"CDM"},{"code":"30768003268","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31382055705","type":"CDM"},{"code":"31382055705","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31604002673","type":"CDM"},{"code":"31604002673","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722000530","type":"CDM"},{"code":"31722000530","type":"NDC"}],"standard_charges":[{"gross_charge":22.06,"discounted_cash":15.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESALAMINE SUPPOS 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722000532","type":"CDM"},{"code":"31722000532","type":"NDC"}],"standard_charges":[{"gross_charge":23.63,"discounted_cash":16.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722013130","type":"CDM"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722020320","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"31722020320","type":"NDC"}],"standard_charges":[{"gross_charge":55.18,"discounted_cash":38.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx31722020331","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"31722020331","type":"NDC"}],"standard_charges":[{"gross_charge":34.29,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"31722030801","type":"NDC"}],"standard_charges":[{"gross_charge":104.62,"discounted_cash":73.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053712","type":"CDM"},{"code":"31722053712","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722077701","type":"CDM"},{"code":"31722077701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722083260","type":"CDM"},{"code":"31722083260","type":"NDC"}],"standard_charges":[{"gross_charge":25.47,"discounted_cash":17.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMPLE - SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx31722093747","type":"CDM"},{"code":"31722093747","type":"NDC"}],"standard_charges":[{"gross_charge":70.95,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx31722093847","type":"CDM"},{"code":"31722093847","type":"NDC"}],"standard_charges":[{"gross_charge":68.11,"discounted_cash":47.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx31722098110","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"31722098110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx31722098131","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"31722098131","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002507","type":"CDM"},{"code":"33342002507","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342003310","type":"CDM"},{"code":"33342003310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006807","type":"CDM"},{"code":"33342006807","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009302","type":"CDM"},{"code":"33342009302","type":"NDC"}],"standard_charges":[{"gross_charge":22.36,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.9,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009402","type":"CDM"},{"code":"33342009402","type":"NDC"}],"standard_charges":[{"gross_charge":17.7,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009441","type":"CDM"},{"code":"33342009441","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009607","type":"CDM"},{"code":"33342009607","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342011107","type":"CDM"},{"code":"33342011107","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx33342033315","type":"CDM"},{"code":"33342033315","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE OINT 0.1%","drug_information":{"unit":80.0,"type":"GM"},"code_information":[{"code":"Rx33342033380","type":"CDM"},{"code":"33342033380","type":"NDC"}],"standard_charges":[{"gross_charge":55.84,"discounted_cash":39.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx33342050660","type":"CDM"},{"code":"33342050660","type":"NDC"}],"standard_charges":[{"gross_charge":125.66,"discounted_cash":87.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx36000000824","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000824","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000014801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"36000014801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000014810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"36000014810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000024401","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"36000024401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000024425","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"36000024425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000028225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx36000028425","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000030801","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000030801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx36000030810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx36000032001","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx36000032010","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx36000032201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx36000032202","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000002410","type":"CDM"},{"code":"37000002410","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000025445","type":"CDM"},{"code":"37000025445","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205011278","type":"CDM"},{"code":"37205011278","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205018581","type":"CDM"},{"code":"37205018581","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864008289","type":"CDM"},{"code":"37864008289","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864085099","type":"CDM"},{"code":"37864085099","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE (BULK) POWDER","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx38779000904","type":"CDM"},{"code":"38779000904","type":"NDC"}],"standard_charges":[{"gross_charge":489.51,"discounted_cash":342.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL POWDER","drug_information":{"unit":0.001,"type":"GM"},"code_information":[{"code":"Rx38779024704","type":"CDM"},{"code":"38779024704","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMPLE - SYRUP","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx38779177908","type":"CDM"},{"code":"38779177908","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ORAL VEHICLES","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx38779251008","type":"CDM"},{"code":"38779251008","type":"NDC"}],"standard_charges":[{"gross_charge":68.11,"discounted_cash":47.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":73.78,"discounted_cash":51.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006412","type":"CDM"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":79.46,"discounted_cash":55.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39328012005","type":"CDM"},{"code":"39328012005","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39328012050","type":"CDM"},{"code":"39328012050","type":"NDC"}],"standard_charges":[{"gross_charge":8.91,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39328015705","type":"CDM"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822019001","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":285.25,"discounted_cash":199.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822027801","type":"CDM"},{"code":"39822027801","type":"NDC"}],"standard_charges":[{"gross_charge":44.03,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx39822050001","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"39822050001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":368.14,"discounted_cash":257.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx39822110001","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx39822200001","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":138.65,"discounted_cash":97.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACTINOMYCIN FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822210002","type":"CDM"},{"code":"J9120","type":"HCPCS"},{"code":"39822210002","type":"NDC"}],"standard_charges":[{"gross_charge":3727.81,"discounted_cash":2609.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822305001","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"39822305001","type":"NDC"}],"standard_charges":[{"gross_charge":790.74,"discounted_cash":553.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENTAMIDINE ISETHIONATE FOR INJ SOLN 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822305002","type":"CDM"},{"code":"S0080","type":"HCPCS"},{"code":"39822305002","type":"NDC"}],"standard_charges":[{"gross_charge":585.15,"discounted_cash":409.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40093010588","type":"CDM"},{"code":"40093010588","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40093010609","type":"CDM"},{"code":"40093010609","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CADEXOMER IODINE GEL 0.9%","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx40565012255","type":"CDM"},{"code":"40565012255","type":"NDC"}],"standard_charges":[{"gross_charge":116.31,"discounted_cash":81.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CADEXOMER IODINE GEL 0.9%","drug_information":{"unit":10.0,"type":"GM"},"code_information":[{"code":"Rx40565012256","type":"CDM"},{"code":"40565012256","type":"NDC"}],"standard_charges":[{"gross_charge":172.61,"discounted_cash":120.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TROLAMINE SALICYLATE CREAM 10%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx41167005723","type":"CDM"},{"code":"41167005723","type":"NDC"}],"standard_charges":[{"gross_charge":36.72,"discounted_cash":25.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx42023012901","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"42023012901","type":"NDC"}],"standard_charges":[{"gross_charge":48.69,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016401","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016401","type":"NDC"}],"standard_charges":[{"gross_charge":162.05,"discounted_cash":113.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016425","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023020101","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"42023020101","type":"NDC"}],"standard_charges":[{"gross_charge":653.4,"discounted_cash":457.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx42023024301","type":"CDM"},{"code":"42023024301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx42023024399","type":"CDM"},{"code":"42023024399","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx42037010478","type":"CDM"},{"code":"42037010478","type":"NDC"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":26.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42192060816","type":"CDM"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292000101","type":"CDM"},{"code":"42292000101","type":"NDC"}],"standard_charges":[{"gross_charge":17.17,"discounted_cash":12.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292001801","type":"CDM"},{"code":"42292001801","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003801","type":"CDM"},{"code":"42292003801","type":"NDC"}],"standard_charges":[{"gross_charge":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.67,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.83,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003920","type":"CDM"},{"code":"42292003920","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":8170.75,"discounted_cash":5719.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.1,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041501","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041501","type":"NDC"}],"standard_charges":[{"gross_charge":156.27,"discounted_cash":109.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041525","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041525","type":"NDC"}],"standard_charges":[{"gross_charge":85.8,"discounted_cash":60.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041601","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041601","type":"NDC"}],"standard_charges":[{"gross_charge":224.76,"discounted_cash":157.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041625","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":83.88,"discounted_cash":58.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543014050","type":"CDM"},{"code":"42543014050","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CITRATE TAB ER 10 MEQ (1080 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42543040701","type":"CDM"},{"code":"42543040701","type":"NDC"}],"standard_charges":[{"gross_charge":15.62,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571016201","type":"CDM"},{"code":"42571016201","type":"NDC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42571026575","type":"CDM"},{"code":"42571026575","type":"NDC"}],"standard_charges":[{"gross_charge":122.42,"discounted_cash":85.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42571027460","type":"CDM"},{"code":"42571027460","type":"NDC"}],"standard_charges":[{"gross_charge":18.73,"discounted_cash":13.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLADRIBINE IV SOLN 10 MG/10ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx42658001001","type":"CDM"},{"code":"J9065","type":"HCPCS"},{"code":"42658001001","type":"NDC"}],"standard_charges":[{"gross_charge":1029.38,"discounted_cash":720.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOGAMULIZUMAB-KPKC IV SOLN 20 MG/5ML (4 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42747076101","type":"CDM"},{"code":"J9204","type":"HCPCS"},{"code":"42747076101","type":"NDC"}],"standard_charges":[{"gross_charge":23498.0,"discounted_cash":16448.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42794001812","type":"CDM"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"gross_charge":17.21,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx42806015134","type":"CDM"},{"code":"42806015134","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858000101","type":"CDM"},{"code":"42858000101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858000110","type":"CDM"},{"code":"42858000110","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858010301","type":"CDM"},{"code":"42858010301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858023450","type":"CDM"},{"code":"42858023450","type":"NDC"}],"standard_charges":[{"gross_charge":32.02,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030101","type":"CDM"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030201","type":"CDM"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030225","type":"CDM"},{"code":"42858030225","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.58,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080101","type":"CDM"},{"code":"42858080101","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43066000801","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"43066000801","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":18.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43066000810","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"43066000810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":26.55,"discounted_cash":18.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066001501","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066001501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066001510","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":594.43,"discounted_cash":416.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066002301","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066002301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43066002310","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066009001","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"43066009001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43066009025","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":114.88,"discounted_cash":80.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":264.19,"discounted_cash":184.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx43066099701","type":"CDM"},{"code":"43066099701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx43066099710","type":"CDM"},{"code":"43066099710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199001301","type":"CDM"},{"code":"43199001301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":140.79,"discounted_cash":98.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx43386009662","type":"CDM"},{"code":"43386009662","type":"NDC"}],"standard_charges":[{"gross_charge":157.41,"discounted_cash":110.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.41,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547026810","type":"CDM"},{"code":"43547026810","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547028010","type":"CDM"},{"code":"43547028010","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547033610","type":"CDM"},{"code":"43547033610","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036703","type":"CDM"},{"code":"43547036703","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040110","type":"CDM"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040210","type":"CDM"},{"code":"43547040210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040310","type":"CDM"},{"code":"43547040310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598005011","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"43598005011","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598005025","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"43598005025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITONIN (SALMON) INJ 200 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43598005111","type":"CDM"},{"code":"J0630","type":"HCPCS"},{"code":"43598005111","type":"NDC"}],"standard_charges":[{"gross_charge":3610.46,"discounted_cash":2527.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598007811","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598007811","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598007858","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598007858","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598008611","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"43598008611","type":"NDC"}],"standard_charges":[{"gross_charge":53.39,"discounted_cash":37.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598008658","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"43598008658","type":"NDC"}],"standard_charges":[{"gross_charge":53.39,"discounted_cash":37.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598010610","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":31.63,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598010611","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"43598010611","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598012811","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598012811","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":82.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598013074","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"gross_charge":105.32,"discounted_cash":73.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598014011","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"43598014011","type":"NDC"}],"standard_charges":[{"gross_charge":101.31,"discounted_cash":70.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598014025","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"43598014025","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":65.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL (PF) IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598017205","type":"CDM"},{"code":"J2372","type":"HCPCS"},{"code":"43598017205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL (PF) IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598017215","type":"CDM"},{"code":"J2372","type":"HCPCS"},{"code":"43598017215","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL (PF) IV SOLN 0.5 MG/5ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598017225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"43598017225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598026211","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"43598026211","type":"NDC"}],"standard_charges":[{"gross_charge":1305.91,"discounted_cash":914.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx43598026223","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"43598026223","type":"NDC"}],"standard_charges":[{"gross_charge":462.27,"discounted_cash":323.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598029266","type":"CDM"},{"code":"43598029266","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598029279","type":"CDM"},{"code":"43598029279","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598029466","type":"CDM"},{"code":"43598029466","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598029479","type":"CDM"},{"code":"43598029479","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598030562","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":212.21,"discounted_cash":148.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598038662","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"43598038662","type":"NDC"}],"standard_charges":[{"gross_charge":151.14,"discounted_cash":105.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598038711","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"43598038711","type":"NDC"}],"standard_charges":[{"gross_charge":851.5,"discounted_cash":596.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598040511","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx43598040511","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598040516","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx43598040516","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598041311","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"gross_charge":124.79,"discounted_cash":87.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044671","type":"CDM"},{"code":"43598044671","type":"NDC"}],"standard_charges":[{"gross_charge":7.89,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044674","type":"CDM"},{"code":"43598044674","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044771","type":"CDM"},{"code":"43598044771","type":"NDC"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044774","type":"CDM"},{"code":"43598044774","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044828","type":"CDM"},{"code":"43598044828","type":"NDC"}],"standard_charges":[{"gross_charge":8.94,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044871","type":"CDM"},{"code":"43598044871","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":13.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598047801","type":"CDM"},{"code":"43598047801","type":"NDC"}],"standard_charges":[{"gross_charge":72.42,"discounted_cash":50.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE PACKET 0.8 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598047890","type":"CDM"},{"code":"43598047890","type":"NDC"}],"standard_charges":[{"gross_charge":85.94,"discounted_cash":60.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6040.84,"discounted_cash":4228.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057901","type":"CDM"},{"code":"43598057901","type":"NDC"}],"standard_charges":[{"gross_charge":30.34,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057930","type":"CDM"},{"code":"43598057930","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058201","type":"CDM"},{"code":"43598058201","type":"NDC"}],"standard_charges":[{"gross_charge":66.29,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058230","type":"CDM"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":20.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43598058723","type":"CDM"},{"code":"43598058723","type":"NDC"}],"standard_charges":[{"gross_charge":81.91,"discounted_cash":57.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 10 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598067611","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"43598067611","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598069811","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"43598069811","type":"NDC"}],"standard_charges":[{"gross_charge":152.02,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598069858","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"43598069858","type":"NDC"}],"standard_charges":[{"gross_charge":159.84,"discounted_cash":111.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598072511","type":"CDM"},{"code":"43598072511","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598072525","type":"CDM"},{"code":"43598072525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598084811","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"43598084811","type":"NDC"}],"standard_charges":[{"gross_charge":112.56,"discounted_cash":78.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598084858","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"43598084858","type":"NDC"}],"standard_charges":[{"gross_charge":112.53,"discounted_cash":78.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089110","type":"CDM"},{"code":"43598089110","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089115","type":"CDM"},{"code":"43598089115","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089116","type":"CDM"},{"code":"43598089116","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx43598089152","type":"CDM"},{"code":"43598089152","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598091406","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598091406","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598091411","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598091411","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx43598091425","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"43598091425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598097511","type":"CDM"},{"code":"43598097511","type":"NDC"}],"standard_charges":[{"gross_charge":253.87,"discounted_cash":177.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598097558","type":"CDM"},{"code":"43598097558","type":"NDC"}],"standard_charges":[{"gross_charge":103.82,"discounted_cash":72.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAR GUM PACKET","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43900097647","type":"CDM"},{"code":"43900097647","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AVELUMAB SOLN FOR IV INFUSION 200 MG/10ML (20 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx44087353501","type":"CDM"},{"code":"J9023","type":"HCPCS"},{"code":"44087353501","type":"NDC"}],"standard_charges":[{"gross_charge":14284.31,"discounted_cash":9999.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44206025110","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"44206025110","type":"NDC"}],"standard_charges":[{"gross_charge":351.65,"discounted_cash":246.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44206043605","type":"CDM"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":3492.62,"discounted_cash":2444.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44206043710","type":"CDM"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"gross_charge":4962.01,"discounted_cash":3473.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx44206043820","type":"CDM"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"gross_charge":9924.03,"discounted_cash":6946.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYTOMEGALOVIRUS IMMUNE GLOBULIN (HUMAN) IV SOLN 50 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44206053211","type":"CDM"},{"code":"J0850","type":"HCPCS"},{"code":"44206053211","type":"NDC"}],"standard_charges":[{"gross_charge":6633.94,"discounted_cash":4643.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567022210","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"44567022210","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023525","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023610","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"gross_charge":47.02,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024625","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024625","type":"NDC"}],"standard_charges":[{"gross_charge":57.07,"discounted_cash":39.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567031110","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 20000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567031201","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"44567031201","type":"NDC"}],"standard_charges":[{"gross_charge":160.75,"discounted_cash":112.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567041024","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567042000","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042000","type":"NDC"}],"standard_charges":[{"gross_charge":132.75,"discounted_cash":92.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567042024","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567043624","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx44567043724","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567045001","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"44567045001","type":"NDC"}],"standard_charges":[{"gross_charge":882.36,"discounted_cash":617.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567045010","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"44567045010","type":"NDC"}],"standard_charges":[{"gross_charge":681.12,"discounted_cash":476.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 200 MG/200ML (1 MG/ML)","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx44567051101","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"44567051101","type":"NDC"}],"standard_charges":[{"gross_charge":526.12,"discounted_cash":368.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 1000 MCG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx44567060104","type":"CDM"},{"code":"44567060104","type":"NDC"}],"standard_charges":[{"gross_charge":316.85,"discounted_cash":221.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx44567062001","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062001","type":"NDC"}],"standard_charges":[{"gross_charge":66.8,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":66.8,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064101","type":"CDM"},{"code":"44567064101","type":"NDC"}],"standard_charges":[{"gross_charge":425.7,"discounted_cash":297.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 8 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064110","type":"CDM"},{"code":"44567064110","type":"NDC"}],"standard_charges":[{"gross_charge":221.88,"discounted_cash":155.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 16 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064201","type":"CDM"},{"code":"44567064201","type":"NDC"}],"standard_charges":[{"gross_charge":712.08,"discounted_cash":498.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE-NACL IV SOLUTION 16 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx44567064210","type":"CDM"},{"code":"44567064210","type":"NDC"}],"standard_charges":[{"gross_charge":492.78,"discounted_cash":344.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070125","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070501","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"44567070501","type":"NDC"}],"standard_charges":[{"gross_charge":268.86,"discounted_cash":188.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070510","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"gross_charge":80.38,"discounted_cash":56.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070725","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"44567070725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567082001","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"44567082001","type":"NDC"}],"standard_charges":[{"gross_charge":516.09,"discounted_cash":361.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567082010","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"gross_charge":139.51,"discounted_cash":97.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LANOLIN CREAM","drug_information":{"unit":7.0,"type":"GM"},"code_information":[{"code":"Rx44677010202","type":"CDM"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"gross_charge":16.96,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 40 MG/ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45802005705","type":"CDM"},{"code":"45802005705","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx45802005911","type":"CDM"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":79.04,"discounted_cash":55.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802006003","type":"CDM"},{"code":"45802006003","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802006435","type":"CDM"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx45802009846","type":"CDM"},{"code":"45802009846","type":"NDC"}],"standard_charges":[{"gross_charge":104.38,"discounted_cash":73.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":88.53,"discounted_cash":61.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx45802011222","type":"CDM"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":96.36,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx45802013970","type":"CDM"},{"code":"45802013970","type":"NDC"}],"standard_charges":[{"gross_charge":209.66,"discounted_cash":146.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx45802043321","type":"CDM"},{"code":"45802043321","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802043803","type":"CDM"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":227.0,"type":"GM"},"code_information":[{"code":"Rx45802052555","type":"CDM"},{"code":"45802052555","type":"NDC"}],"standard_charges":[{"gross_charge":44.94,"discounted_cash":31.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802057800","type":"CDM"},{"code":"45802057800","type":"NDC"}],"standard_charges":[{"gross_charge":219.99,"discounted_cash":153.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802057884","type":"CDM"},{"code":"45802057884","type":"NDC"}],"standard_charges":[{"gross_charge":109.98,"discounted_cash":76.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073000","type":"CDM"},{"code":"45802073000","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073200","type":"CDM"},{"code":"45802073200","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073230","type":"CDM"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802081100","type":"CDM"},{"code":"45802081100","type":"NDC"}],"standard_charges":[{"gross_charge":167.31,"discounted_cash":117.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL INJ 2 MG/ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx45963073360","type":"CDM"},{"code":"J9000","type":"HCPCS"},{"code":"45963073360","type":"NDC"}],"standard_charges":[{"gross_charge":698.51,"discounted_cash":488.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":102.5,"discounted_cash":71.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx47335004940","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":2282.63,"discounted_cash":1597.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx47335005040","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":5267.05,"discounted_cash":3686.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335006186","type":"CDM"},{"code":"47335006186","type":"NDC"}],"standard_charges":[{"gross_charge":21.41,"discounted_cash":14.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335006286","type":"CDM"},{"code":"47335006286","type":"NDC"}],"standard_charges":[{"gross_charge":21.41,"discounted_cash":14.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TILDRAKIZUMAB-ASMN SUBCUTANEOUS SOLN PREF SYRINGE 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx47335017795","type":"CDM"},{"code":"J3245","type":"HCPCS"},{"code":"47335017795","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":55671.91,"discounted_cash":38970.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335048583","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"47335048583","type":"NDC"}],"standard_charges":[{"gross_charge":16.33,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335048588","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"47335048588","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":11.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":44.82,"discounted_cash":31.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2006.52,"discounted_cash":1404.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781001301","type":"CDM"},{"code":"47781001301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781017601","type":"CDM"},{"code":"47781017601","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781022901","type":"CDM"},{"code":"47781022901","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035503","type":"CDM"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"gross_charge":24.37,"discounted_cash":17.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035511","type":"CDM"},{"code":"47781035511","type":"NDC"}],"standard_charges":[{"gross_charge":22.73,"discounted_cash":15.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035703","type":"CDM"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035711","type":"CDM"},{"code":"47781035711","type":"NDC"}],"standard_charges":[{"gross_charge":28.14,"discounted_cash":19.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042411","type":"CDM"},{"code":"47781042411","type":"NDC"}],"standard_charges":[{"gross_charge":71.45,"discounted_cash":50.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042447","type":"CDM"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"gross_charge":61.76,"discounted_cash":43.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042611","type":"CDM"},{"code":"47781042611","type":"NDC"}],"standard_charges":[{"gross_charge":114.89,"discounted_cash":80.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042711","type":"CDM"},{"code":"47781042711","type":"NDC"}],"standard_charges":[{"gross_charge":157.03,"discounted_cash":109.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042747","type":"CDM"},{"code":"47781042747","type":"NDC"}],"standard_charges":[{"gross_charge":106.35,"discounted_cash":74.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042811","type":"CDM"},{"code":"47781042811","type":"NDC"}],"standard_charges":[{"gross_charge":117.92,"discounted_cash":82.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042847","type":"CDM"},{"code":"47781042847","type":"NDC"}],"standard_charges":[{"gross_charge":136.5,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERGOCALCIFEROL SOLN 200 MCG/ML (8000 UNIT/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx47781064726","type":"CDM"},{"code":"47781064726","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48433010401","type":"CDM"},{"code":"48433010401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx48433020230","type":"CDM"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7.56,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx48433021905","type":"CDM"},{"code":"48433021905","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx48433021940","type":"CDM"},{"code":"48433021940","type":"NDC"}],"standard_charges":[{"gross_charge":14.82,"discounted_cash":10.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":273.87,"discounted_cash":191.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":44.3,"type":"ML"},"code_information":[{"code":"Rx48582000155","type":"CDM"},{"code":"48582000155","type":"NDC"}],"standard_charges":[{"gross_charge":42.79,"discounted_cash":29.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTOBACILLUS RHAMNOSUS (GG) CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49100038164","type":"CDM"},{"code":"49100038164","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTOBACILLUS RHAMNOSUS (GG) CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49100040007","type":"CDM"},{"code":"49100040007","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERITONEAL DIALYSIS SOLUTIONS 394 MOSM/L","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"Rx49230020994","type":"CDM"},{"code":"49230020994","type":"NDC"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":73.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281057500","type":"CDM"},{"code":"90380","type":"HCPCS"},{"code":"49281057500","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIRSEVIMAB-ALIP IM SOLN PREFILLED SYRINGE 50 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281057515","type":"CDM"},{"code":"90380","type":"HCPCS"},{"code":"49281057515","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075221","type":"CDM"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":92.96,"discounted_cash":65.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075278","type":"CDM"},{"code":"49281075278","type":"NDC"}],"standard_charges":[{"gross_charge":49.43,"discounted_cash":34.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3981.21,"discounted_cash":2786.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9426.29,"discounted_cash":6598.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49483008001","type":"CDM"},{"code":"49483008001","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010101","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010101","type":"NDC"}],"standard_charges":[{"gross_charge":1153.1,"discounted_cash":807.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502010201","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"49502010201","type":"NDC"}],"standard_charges":[{"gross_charge":1153.1,"discounted_cash":807.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADALIMUMAB-FKJP PREFILLED SYRINGE KIT 40 MG/0.8ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49502041802","type":"CDM"},{"code":"Q5140","type":"HCPCS"},{"code":"49502041802","type":"NDC"}],"standard_charges":[{"gross_charge":2986.31,"discounted_cash":2090.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx49502060561","type":"CDM"},{"code":"J7606","type":"HCPCS"},{"code":"49502060561","type":"NDC"}],"standard_charges":[{"gross_charge":37.63,"discounted_cash":26.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx49502060595","type":"CDM"},{"code":"49502060595","type":"NDC"}],"standard_charges":[{"gross_charge":35.69,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CABOTEGRAVIR IM EXTENDED RELEASE SUSP 600 MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx49702026423","type":"CDM"},{"code":"J0739","type":"HCPCS"},{"code":"49702026423","type":"NDC"}],"standard_charges":[{"gross_charge":17582.34,"discounted_cash":12307.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":0.09,"type":"ML"},"code_information":[{"code":"Rx49884016111","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030702","type":"CDM"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"gross_charge":17.41,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030752","type":"CDM"},{"code":"49884030752","type":"NDC"}],"standard_charges":[{"gross_charge":18.7,"discounted_cash":13.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030802","type":"CDM"},{"code":"49884030802","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884030852","type":"CDM"},{"code":"49884030852","type":"NDC"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884046663","type":"CDM"},{"code":"49884046663","type":"NDC"}],"standard_charges":[{"gross_charge":23.53,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884077052","type":"CDM"},{"code":"49884077052","type":"NDC"}],"standard_charges":[{"gross_charge":375.83,"discounted_cash":263.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884077054","type":"CDM"},{"code":"49884077054","type":"NDC"}],"standard_charges":[{"gross_charge":334.22,"discounted_cash":233.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111056001","type":"CDM"},{"code":"50111056001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111056101","type":"CDM"},{"code":"50111056101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228017901","type":"CDM"},{"code":"50228017901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228037930","type":"CDM"},{"code":"50228037930","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228045701","type":"CDM"},{"code":"50228045701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228048101","type":"CDM"},{"code":"50228048101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242000901","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242000901","type":"NDC"}],"standard_charges":[{"gross_charge":33398.06,"discounted_cash":23378.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242001403","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242001403","type":"NDC"}],"standard_charges":[{"gross_charge":33398.06,"discounted_cash":23378.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004110","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004110","type":"NDC"}],"standard_charges":[{"gross_charge":1482.1,"discounted_cash":1037.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1482.17,"discounted_cash":1037.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17711.58,"discounted_cash":12398.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":6973.75,"discounted_cash":4881.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITUXIMAB IV SOLN 100 MG/10ML,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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":28979.42,"discounted_cash":20285.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5915.48,"discounted_cash":4140.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":19665.3,"discounted_cash":13765.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OBINUTUZUMAB SOLN FOR IV INFUSION 1000 MG/40ML (25 MG/ML)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx50242007001","type":"CDM"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":53132.01,"discounted_cash":37192.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE FOR IV SOLN 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008701","type":"CDM"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":39379.17,"discounted_cash":27565.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24612.01,"discounted_cash":17228.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":389.17,"discounted_cash":272.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":498.8,"discounted_cash":349.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ FOR IV SOLUTION 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242010301","type":"CDM"},{"code":"J9309","type":"HCPCS"},{"code":"50242010301","type":"NDC"}],"standard_charges":[{"gross_charge":24603.02,"discounted_cash":17222.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ FOR IV SOLUTION 140 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242010501","type":"CDM"},{"code":"J9309","type":"HCPCS"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":114813.77,"discounted_cash":80369.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33398.06,"discounted_cash":23378.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11055.99,"discounted_cash":7739.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 80 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx50242013501","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":4250.28,"discounted_cash":2975.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 200 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50242013601","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":5343.33,"discounted_cash":3740.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50242013701","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":10686.66,"discounted_cash":7480.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42075.6,"discounted_cash":29452.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":90160.76,"discounted_cash":63112.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33398.06,"discounted_cash":23378.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 75 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021401","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021401","type":"NDC"}],"standard_charges":[{"gross_charge":4353.93,"discounted_cash":3047.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 75 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021403","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021403","type":"NDC"}],"standard_charges":[{"gross_charge":4528.08,"discounted_cash":3169.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx50242021501","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021501","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":4353.93,"discounted_cash":3047.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242021503","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242021503","type":"NDC"}],"standard_charges":[{"gross_charge":4528.08,"discounted_cash":3169.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 300 MG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx50242022701","type":"CDM"},{"code":"J2357","type":"HCPCS"},{"code":"50242022701","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATEZOLIZUMAB IV SOLN 1200 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50242091701","type":"CDM"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":71494.8,"discounted_cash":50046.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATEZOLIZUMAB IV SOLN 840 MG/14ML","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"Rx50242091801","type":"CDM"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":48588.73,"discounted_cash":34012.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003711","type":"CDM"},{"code":"50268003711","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003715","type":"CDM"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268004111","type":"CDM"},{"code":"50268004111","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268004115","type":"CDM"},{"code":"50268004115","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005411","type":"CDM"},{"code":"50268005411","type":"NDC"}],"standard_charges":[{"gross_charge":22.95,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005415","type":"CDM"},{"code":"50268005415","type":"NDC"}],"standard_charges":[{"gross_charge":23.62,"discounted_cash":16.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006111","type":"CDM"},{"code":"50268006111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006115","type":"CDM"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007411","type":"CDM"},{"code":"50268007411","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007415","type":"CDM"},{"code":"50268007415","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007511","type":"CDM"},{"code":"50268007511","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007515","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"50268007515","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268008611","type":"CDM"},{"code":"50268008611","type":"NDC"}],"standard_charges":[{"gross_charge":109.33,"discounted_cash":76.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE SUSP 750 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268008612","type":"CDM"},{"code":"50268008612","type":"NDC"}],"standard_charges":[{"gross_charge":128.05,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008711","type":"CDM"},{"code":"50268008711","type":"NDC"}],"standard_charges":[{"gross_charge":36.96,"discounted_cash":25.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008712","type":"CDM"},{"code":"50268008712","type":"NDC"}],"standard_charges":[{"gross_charge":18.31,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008811","type":"CDM"},{"code":"50268008811","type":"NDC"}],"standard_charges":[{"gross_charge":88.98,"discounted_cash":62.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268008815","type":"CDM"},{"code":"50268008815","type":"NDC"}],"standard_charges":[{"gross_charge":16.29,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010511","type":"CDM"},{"code":"50268010511","type":"NDC"}],"standard_charges":[{"gross_charge":19.79,"discounted_cash":13.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010515","type":"CDM"},{"code":"50268010515","type":"NDC"}],"standard_charges":[{"gross_charge":19.45,"discounted_cash":13.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010611","type":"CDM"},{"code":"50268010611","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010615","type":"CDM"},{"code":"50268010615","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011011","type":"CDM"},{"code":"50268011011","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.33,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268012711","type":"CDM"},{"code":"50268012711","type":"NDC"}],"standard_charges":[{"gross_charge":18.16,"discounted_cash":12.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268012715","type":"CDM"},{"code":"50268012715","type":"NDC"}],"standard_charges":[{"gross_charge":18.76,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268012811","type":"CDM"},{"code":"50268012811","type":"NDC"}],"standard_charges":[{"gross_charge":24.97,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268012815","type":"CDM"},{"code":"50268012815","type":"NDC"}],"standard_charges":[{"gross_charge":24.97,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013111","type":"CDM"},{"code":"50268013111","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013115","type":"CDM"},{"code":"50268013115","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013511","type":"CDM"},{"code":"50268013511","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013515","type":"CDM"},{"code":"50268013515","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014211","type":"CDM"},{"code":"50268014211","type":"NDC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014215","type":"CDM"},{"code":"50268014215","type":"NDC"}],"standard_charges":[{"gross_charge":17.74,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015111","type":"CDM"},{"code":"50268015111","type":"NDC"}],"standard_charges":[{"gross_charge":15.96,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015115","type":"CDM"},{"code":"50268015115","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015215","type":"CDM"},{"code":"50268015215","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016311","type":"CDM"},{"code":"50268016311","type":"NDC"}],"standard_charges":[{"gross_charge":29.49,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016315","type":"CDM"},{"code":"50268016315","type":"NDC"}],"standard_charges":[{"gross_charge":24.44,"discounted_cash":17.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016711","type":"CDM"},{"code":"50268016711","type":"NDC"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":13.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016715","type":"CDM"},{"code":"50268016715","type":"NDC"}],"standard_charges":[{"gross_charge":17.56,"discounted_cash":12.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016811","type":"CDM"},{"code":"50268016811","type":"NDC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016815","type":"CDM"},{"code":"50268016815","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016911","type":"CDM"},{"code":"50268016911","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":14.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016915","type":"CDM"},{"code":"50268016915","type":"NDC"}],"standard_charges":[{"gross_charge":19.31,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018911","type":"CDM"},{"code":"50268018911","type":"NDC"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018915","type":"CDM"},{"code":"50268018915","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019111","type":"CDM"},{"code":"50268019111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019115","type":"CDM"},{"code":"50268019115","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019211","type":"CDM"},{"code":"50268019211","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019215","type":"CDM"},{"code":"50268019215","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268025911","type":"CDM"},{"code":"50268025911","type":"NDC"}],"standard_charges":[{"gross_charge":15.81,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268025915","type":"CDM"},{"code":"50268025915","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268026011","type":"CDM"},{"code":"50268026011","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268026013","type":"CDM"},{"code":"50268026013","type":"NDC"}],"standard_charges":[{"gross_charge":18.53,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268027011","type":"CDM"},{"code":"50268027011","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":13.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268027013","type":"CDM"},{"code":"50268027013","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":12.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268027911","type":"CDM"},{"code":"50268027911","type":"NDC"}],"standard_charges":[{"gross_charge":20.37,"discounted_cash":14.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268028211","type":"CDM"},{"code":"50268028211","type":"NDC"}],"standard_charges":[{"gross_charge":18.29,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031211","type":"CDM"},{"code":"50268031211","type":"NDC"}],"standard_charges":[{"gross_charge":19.97,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.35,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031311","type":"CDM"},{"code":"50268031311","type":"NDC"}],"standard_charges":[{"gross_charge":19.57,"discounted_cash":13.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031315","type":"CDM"},{"code":"50268031315","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032011","type":"CDM"},{"code":"50268032011","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032015","type":"CDM"},{"code":"50268032015","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.24,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.5,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268033611","type":"CDM"},{"code":"50268033611","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FERROUS SULFATE SOLN 300 MG/5ML (60 MG/5ML ELEMENTAL FE)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268033624","type":"CDM"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":19.86,"discounted_cash":13.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 400 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268034611","type":"CDM"},{"code":"50268034611","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 400 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268034615","type":"CDM"},{"code":"50268034615","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035811","type":"CDM"},{"code":"50268035811","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035815","type":"CDM"},{"code":"50268035815","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035911","type":"CDM"},{"code":"50268035911","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035915","type":"CDM"},{"code":"50268035915","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039911","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"50268039911","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039950","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"50268039950","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040211","type":"CDM"},{"code":"50268040211","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040215","type":"CDM"},{"code":"50268040215","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040511","type":"CDM"},{"code":"50268040511","type":"NDC"}],"standard_charges":[{"gross_charge":21.12,"discounted_cash":14.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040515","type":"CDM"},{"code":"50268040515","type":"NDC"}],"standard_charges":[{"gross_charge":21.23,"discounted_cash":14.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268041211","type":"CDM"},{"code":"50268041211","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.62,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043011","type":"CDM"},{"code":"50268043011","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043015","type":"CDM"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268044811","type":"CDM"},{"code":"50268044811","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268044815","type":"CDM"},{"code":"50268044815","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047611","type":"CDM"},{"code":"50268047611","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.03,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047811","type":"CDM"},{"code":"50268047811","type":"NDC"}],"standard_charges":[{"gross_charge":22.84,"discounted_cash":15.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEFLUNOMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268047815","type":"CDM"},{"code":"50268047815","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":15.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050411","type":"CDM"},{"code":"50268050411","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050415","type":"CDM"},{"code":"50268050415","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050511","type":"CDM"},{"code":"50268050511","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050515","type":"CDM"},{"code":"50268050515","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052011","type":"CDM"},{"code":"50268052011","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052015","type":"CDM"},{"code":"50268052015","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052515","type":"CDM"},{"code":"50268052515","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052711","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"50268052711","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052715","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"50268052715","type":"NDC"}],"standard_charges":[{"gross_charge":19.36,"discounted_cash":13.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053111","type":"CDM"},{"code":"50268053111","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053511","type":"CDM"},{"code":"50268053511","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053515","type":"CDM"},{"code":"50268053515","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054111","type":"CDM"},{"code":"50268054111","type":"NDC"}],"standard_charges":[{"gross_charge":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054115","type":"CDM"},{"code":"50268054115","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055011","type":"CDM"},{"code":"50268055011","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055015","type":"CDM"},{"code":"50268055015","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055111","type":"CDM"},{"code":"50268055111","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055115","type":"CDM"},{"code":"50268055115","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055311","type":"CDM"},{"code":"50268055311","type":"NDC"}],"standard_charges":[{"gross_charge":20.8,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055313","type":"CDM"},{"code":"50268055313","type":"NDC"}],"standard_charges":[{"gross_charge":19.7,"discounted_cash":13.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055711","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055711","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055715","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055715","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055811","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055811","type":"NDC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055815","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"50268055815","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057011","type":"CDM"},{"code":"50268057011","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057012","type":"CDM"},{"code":"50268057012","type":"NDC"}],"standard_charges":[{"gross_charge":61.65,"discounted_cash":43.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057411","type":"CDM"},{"code":"50268057411","type":"NDC"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057415","type":"CDM"},{"code":"50268057415","type":"NDC"}],"standard_charges":[{"gross_charge":17.79,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057511","type":"CDM"},{"code":"50268057511","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058211","type":"CDM"},{"code":"50268058211","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058215","type":"CDM"},{"code":"50268058215","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058311","type":"CDM"},{"code":"50268058311","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5.11,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058511","type":"CDM"},{"code":"50268058511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058515","type":"CDM"},{"code":"50268058515","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059411","type":"CDM"},{"code":"50268059411","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059611","type":"CDM"},{"code":"50268059611","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059711","type":"CDM"},{"code":"50268059711","type":"NDC"}],"standard_charges":[{"gross_charge":17.44,"discounted_cash":12.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059715","type":"CDM"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060411","type":"CDM"},{"code":"50268060411","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060415","type":"CDM"},{"code":"50268060415","type":"NDC"}],"standard_charges":[{"gross_charge":16.36,"discounted_cash":11.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061511","type":"CDM"},{"code":"50268061511","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061513","type":"CDM"},{"code":"50268061513","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":15.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062511","type":"CDM"},{"code":"50268062511","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062515","type":"CDM"},{"code":"50268062515","type":"NDC"}],"standard_charges":[{"gross_charge":25.93,"discounted_cash":18.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063011","type":"CDM"},{"code":"50268063011","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063015","type":"CDM"},{"code":"50268063015","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063911","type":"CDM"},{"code":"50268063911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063915","type":"CDM"},{"code":"50268063915","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064411","type":"CDM"},{"code":"50268064411","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268064415","type":"CDM"},{"code":"50268064415","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268066211","type":"CDM"},{"code":"50268066211","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268066215","type":"CDM"},{"code":"50268066215","type":"NDC"}],"standard_charges":[{"gross_charge":15.22,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx50268067411","type":"CDM"},{"code":"50268067411","type":"NDC"}],"standard_charges":[{"gross_charge":21.92,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx50268067415","type":"CDM"},{"code":"50268067415","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068511","type":"CDM"},{"code":"50268068511","type":"NDC"}],"standard_charges":[{"gross_charge":18.53,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068515","type":"CDM"},{"code":"50268068515","type":"NDC"}],"standard_charges":[{"gross_charge":19.79,"discounted_cash":13.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068611","type":"CDM"},{"code":"50268068611","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068615","type":"CDM"},{"code":"50268068615","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070911","type":"CDM"},{"code":"50268070911","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070915","type":"CDM"},{"code":"50268070915","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071011","type":"CDM"},{"code":"50268071011","type":"NDC"}],"standard_charges":[{"gross_charge":17.68,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071015","type":"CDM"},{"code":"50268071015","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071711","type":"CDM"},{"code":"50268071711","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072011","type":"CDM"},{"code":"50268072011","type":"NDC"}],"standard_charges":[{"gross_charge":24.73,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072015","type":"CDM"},{"code":"50268072015","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072211","type":"CDM"},{"code":"50268072211","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072215","type":"CDM"},{"code":"50268072215","type":"NDC"}],"standard_charges":[{"gross_charge":21.08,"discounted_cash":14.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072411","type":"CDM"},{"code":"50268072411","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":13.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072415","type":"CDM"},{"code":"50268072415","type":"NDC"}],"standard_charges":[{"gross_charge":15.22,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072511","type":"CDM"},{"code":"50268072511","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072515","type":"CDM"},{"code":"50268072515","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268073011","type":"CDM"},{"code":"50268073011","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268073111","type":"CDM"},{"code":"50268073111","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50268073124","type":"CDM"},{"code":"50268073124","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074111","type":"CDM"},{"code":"50268074111","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074115","type":"CDM"},{"code":"50268074115","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.53,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075611","type":"CDM"},{"code":"50268075611","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075615","type":"CDM"},{"code":"50268075615","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075911","type":"CDM"},{"code":"50268075911","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075915","type":"CDM"},{"code":"50268075915","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076011","type":"CDM"},{"code":"50268076011","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076015","type":"CDM"},{"code":"50268076015","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076411","type":"CDM"},{"code":"50268076411","type":"NDC"}],"standard_charges":[{"gross_charge":16.86,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076415","type":"CDM"},{"code":"50268076415","type":"NDC"}],"standard_charges":[{"gross_charge":17.41,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076611","type":"CDM"},{"code":"50268076611","type":"NDC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076615","type":"CDM"},{"code":"50268076615","type":"NDC"}],"standard_charges":[{"gross_charge":16.96,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268079811","type":"CDM"},{"code":"50268079811","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081611","type":"CDM"},{"code":"50268081611","type":"NDC"}],"standard_charges":[{"gross_charge":15.99,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081615","type":"CDM"},{"code":"50268081615","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085211","type":"CDM"},{"code":"50268085211","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085215","type":"CDM"},{"code":"50268085215","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086511","type":"CDM"},{"code":"50268086511","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086515","type":"CDM"},{"code":"50268086515","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086611","type":"CDM"},{"code":"50268086611","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086615","type":"CDM"},{"code":"50268086615","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383034910","type":"CDM"},{"code":"50383034910","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383034911","type":"CDM"},{"code":"50383034911","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383077932","type":"CDM"},{"code":"50383077932","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50383093093","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"50383093093","type":"NDC"}],"standard_charges":[{"gross_charge":20.18,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RADIUM RA 223 DICHLORIDE INJ 30 MICROCURIE/ML (1100 KBQ/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50419020801","type":"CDM"},{"code":"A9606","type":"HCPCS"},{"code":"50419020801","type":"NDC"}],"standard_charges":[{"gross_charge":104414.4,"discounted_cash":73090.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOXETATE DISODIUM IV SOLN 0.25 MMOL/ML (181.43 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032005","type":"CDM"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":394.71,"discounted_cash":276.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032502","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032502","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032512","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032512","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx50419032522","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032522","type":"NDC"}],"standard_charges":[{"gross_charge":92.83,"discounted_cash":64.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032524","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032524","type":"NDC"}],"standard_charges":[{"gross_charge":140.49,"discounted_cash":98.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx50419032527","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032527","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GADOBUTROL INJ 1 MMOL/ML (604.72 MG/ML),GADOBUTROL IV SOLN PREF SYR 10 MMOL/10ML,GADOBUTROL IV SOLN PREF SYR 15 MMOL/15ML,GADOBUTROL IV SOLN PREF SYR 7.5 MMOL/7.5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50419032528","type":"CDM"},{"code":"A9585","type":"HCPCS"},{"code":"50419032528","type":"NDC"}],"standard_charges":[{"gross_charge":92.73,"discounted_cash":64.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 250 MG/5ML (5%) (5 GM/100ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50419077701","type":"CDM"},{"code":"50419077701","type":"NDC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014030","type":"CDM"},{"code":"50458014030","type":"NDC"}],"standard_charges":[{"gross_charge":71.78,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":71.78,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057701","type":"CDM"},{"code":"50458057701","type":"NDC"}],"standard_charges":[{"gross_charge":27.68,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057801","type":"CDM"},{"code":"50458057801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058001","type":"CDM"},{"code":"50458058001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058090","type":"CDM"},{"code":"50458058090","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458059210","type":"CDM"},{"code":"50458059210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx50458059601","type":"CDM"},{"code":"50458059601","type":"NDC"}],"standard_charges":[{"gross_charge":18.73,"discounted_cash":13.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 13.8 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx50474063699","type":"CDM"},{"code":"50474063699","type":"NDC"}],"standard_charges":[{"gross_charge":511.14,"discounted_cash":357.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CERTOLIZUMAB PEGOL FOR INJ KIT 2 X 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50474070062","type":"CDM"},{"code":"J0717","type":"HCPCS"},{"code":"50474070062","type":"NDC"}],"standard_charges":[{"gross_charge":20964.62,"discounted_cash":14675.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 8.5 MG/0.85ML","drug_information":{"unit":0.85,"type":"ML"},"code_information":[{"code":"Rx50474080744","type":"CDM"},{"code":"50474080744","type":"NDC"}],"standard_charges":[{"gross_charge":1142.31,"discounted_cash":799.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 13.8 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx50474080746","type":"CDM"},{"code":"50474080746","type":"NDC"}],"standard_charges":[{"gross_charge":951.91,"discounted_cash":666.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1853.93,"discounted_cash":1297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580041202","type":"CDM"},{"code":"50580041202","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580045711","type":"CDM"},{"code":"50580045711","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580045770","type":"CDM"},{"code":"50580045770","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580045811","type":"CDM"},{"code":"50580045811","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580047511","type":"CDM"},{"code":"50580047511","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580049110","type":"CDM"},{"code":"50580049110","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2312.41,"discounted_cash":1618.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RABIES VACCINE, PCEC FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50632001301","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"50632001301","type":"NDC"}],"standard_charges":[{"gross_charge":2202.25,"discounted_cash":1541.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CROTALIDAE POLYVALENT IMMUNE FAB (OVINE) FOR IV INFUSION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633011011","type":"CDM"},{"code":"J0840","type":"HCPCS"},{"code":"50633011011","type":"NDC"}],"standard_charges":[{"gross_charge":6440.5,"discounted_cash":4508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5147.34,"discounted_cash":3603.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20021.29,"discounted_cash":14014.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633031011","type":"CDM"},{"code":"50633031011","type":"NDC"}],"standard_charges":[{"gross_charge":4015.84,"discounted_cash":2811.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUININE SULFATE CAP 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742023830","type":"CDM"},{"code":"50742023830","type":"NDC"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742023901","type":"CDM"},{"code":"50742023901","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEXILETINE HCL CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742024001","type":"CDM"},{"code":"50742024001","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742026001","type":"CDM"},{"code":"50742026001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742036401","type":"CDM"},{"code":"50742036401","type":"NDC"}],"standard_charges":[{"gross_charge":26.92,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742036430","type":"CDM"},{"code":"50742036430","type":"NDC"}],"standard_charges":[{"gross_charge":30.83,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742048401","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"50742048401","type":"NDC"}],"standard_charges":[{"gross_charge":181.28,"discounted_cash":126.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050501","type":"CDM"},{"code":"50742050501","type":"NDC"}],"standard_charges":[{"gross_charge":91.52,"discounted_cash":64.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":70.61,"discounted_cash":49.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50742052005","type":"CDM"},{"code":"J9073","type":"HCPCS"},{"code":"50742052005","type":"NDC"}],"standard_charges":[{"gross_charge":2864.56,"discounted_cash":2005.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 2 GM/10ML (200 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50742052110","type":"CDM"},{"code":"J9073","type":"HCPCS"},{"code":"50742052110","type":"NDC"}],"standard_charges":[{"gross_charge":4492.06,"discounted_cash":3144.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055001","type":"CDM"},{"code":"50742055001","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":26.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055005","type":"CDM"},{"code":"50742055005","type":"NDC"}],"standard_charges":[{"gross_charge":37.94,"discounted_cash":26.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055201","type":"CDM"},{"code":"50742055201","type":"NDC"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":80.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055205","type":"CDM"},{"code":"50742055205","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":56.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055601","type":"CDM"},{"code":"50742055601","type":"NDC"}],"standard_charges":[{"gross_charge":149.49,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742055605","type":"CDM"},{"code":"50742055605","type":"NDC"}],"standard_charges":[{"gross_charge":128.67,"discounted_cash":90.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAFASITAMAB-CXIX FOR IV SOLN 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50881001303","type":"CDM"},{"code":"J9349","type":"HCPCS"},{"code":"50881001303","type":"NDC"}],"standard_charges":[{"gross_charge":10361.11,"discounted_cash":7252.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002001","type":"CDM"},{"code":"51079002001","type":"NDC"}],"standard_charges":[{"gross_charge":135.64,"discounted_cash":94.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE DELAYED RELEASE PARTICLES CAP 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002003","type":"CDM"},{"code":"51079002003","type":"NDC"}],"standard_charges":[{"gross_charge":140.79,"discounted_cash":98.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":27.41,"discounted_cash":19.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.96,"discounted_cash":20.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.38,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.96,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007201","type":"CDM"},{"code":"51079007201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007220","type":"CDM"},{"code":"51079007220","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007401","type":"CDM"},{"code":"51079007401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007420","type":"CDM"},{"code":"51079007420","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007501","type":"CDM"},{"code":"51079007501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007520","type":"CDM"},{"code":"51079007520","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008601","type":"CDM"},{"code":"51079008601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008620","type":"CDM"},{"code":"51079008620","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010301","type":"CDM"},{"code":"51079010301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010320","type":"CDM"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013101","type":"CDM"},{"code":"51079013101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013120","type":"CDM"},{"code":"51079013120","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014101","type":"CDM"},{"code":"51079014101","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.53,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 450 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014201","type":"CDM"},{"code":"51079014201","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 450 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014220","type":"CDM"},{"code":"51079014220","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016901","type":"CDM"},{"code":"51079016901","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016920","type":"CDM"},{"code":"51079016920","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017001","type":"CDM"},{"code":"51079017001","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017020","type":"CDM"},{"code":"51079017020","type":"NDC"}],"standard_charges":[{"gross_charge":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018001","type":"CDM"},{"code":"51079018001","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018020","type":"CDM"},{"code":"51079018020","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019701","type":"CDM"},{"code":"51079019701","type":"NDC"}],"standard_charges":[{"gross_charge":87.22,"discounted_cash":61.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020501","type":"CDM"},{"code":"51079020501","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.53,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020801","type":"CDM"},{"code":"51079020801","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020820","type":"CDM"},{"code":"51079020820","type":"NDC"}],"standard_charges":[{"gross_charge":15.27,"discounted_cash":10.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020901","type":"CDM"},{"code":"51079020901","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021001","type":"CDM"},{"code":"51079021001","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":11.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021020","type":"CDM"},{"code":"51079021020","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024601","type":"CDM"},{"code":"51079024601","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024620","type":"CDM"},{"code":"51079024620","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025501","type":"CDM"},{"code":"51079025501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028401","type":"CDM"},{"code":"51079028401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028420","type":"CDM"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028501","type":"CDM"},{"code":"51079028501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028520","type":"CDM"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037401","type":"CDM"},{"code":"51079037401","type":"NDC"}],"standard_charges":[{"gross_charge":16.76,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079037420","type":"CDM"},{"code":"51079037420","type":"NDC"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":11.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038501","type":"CDM"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038520","type":"CDM"},{"code":"51079038520","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041701","type":"CDM"},{"code":"51079041701","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"51079043401","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043601","type":"CDM"},{"code":"51079043601","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.78,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043701","type":"CDM"},{"code":"51079043701","type":"NDC"}],"standard_charges":[{"gross_charge":17.17,"discounted_cash":12.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043720","type":"CDM"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044001","type":"CDM"},{"code":"51079044001","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044020","type":"CDM"},{"code":"51079044020","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044101","type":"CDM"},{"code":"51079044101","type":"NDC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044120","type":"CDM"},{"code":"51079044120","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":11.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.98,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.04,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.48,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.04,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.33,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044501","type":"CDM"},{"code":"51079044501","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044520","type":"CDM"},{"code":"51079044520","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 2.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045001","type":"CDM"},{"code":"51079045001","type":"NDC"}],"standard_charges":[{"gross_charge":22.69,"discounted_cash":15.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045301","type":"CDM"},{"code":"51079045301","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045320","type":"CDM"},{"code":"51079045320","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":12.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMVASTATIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045401","type":"CDM"},{"code":"51079045401","type":"NDC"}],"standard_charges":[{"gross_charge":27.93,"discounted_cash":19.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMVASTATIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045420","type":"CDM"},{"code":"51079045420","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045801","type":"CDM"},{"code":"51079045801","type":"NDC"}],"standard_charges":[{"gross_charge":16.97,"discounted_cash":11.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048001","type":"CDM"},{"code":"51079048001","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048020","type":"CDM"},{"code":"51079048020","type":"NDC"}],"standard_charges":[{"gross_charge":16.87,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079051301","type":"CDM"},{"code":"51079051301","type":"NDC"}],"standard_charges":[{"gross_charge":16.91,"discounted_cash":11.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079052701","type":"CDM"},{"code":"51079052701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079052720","type":"CDM"},{"code":"51079052720","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079059701","type":"CDM"},{"code":"51079059701","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079059720","type":"CDM"},{"code":"51079059720","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062001","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062001","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063001","type":"CDM"},{"code":"51079063001","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079063201","type":"CDM"},{"code":"51079063201","type":"NDC"}],"standard_charges":[{"gross_charge":30.59,"discounted_cash":21.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.7,"discounted_cash":24.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068401","type":"CDM"},{"code":"51079068401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069001","type":"CDM"},{"code":"51079069001","type":"NDC"}],"standard_charges":[{"gross_charge":17.3,"discounted_cash":12.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072101","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072101","type":"NDC"}],"standard_charges":[{"gross_charge":15.97,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.41,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072201","type":"CDM"},{"code":"51079072201","type":"NDC"}],"standard_charges":[{"gross_charge":24.61,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072401","type":"CDM"},{"code":"51079072401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073401","type":"CDM"},{"code":"51079073401","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073601","type":"CDM"},{"code":"51079073601","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":11.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074501","type":"CDM"},{"code":"51079074501","type":"NDC"}],"standard_charges":[{"gross_charge":16.33,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075301","type":"CDM"},{"code":"51079075301","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075320","type":"CDM"},{"code":"51079075320","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076601","type":"CDM"},{"code":"51079076601","type":"NDC"}],"standard_charges":[{"gross_charge":19.57,"discounted_cash":13.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076608","type":"CDM"},{"code":"51079076608","type":"NDC"}],"standard_charges":[{"gross_charge":21.17,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079076701","type":"CDM"},{"code":"51079076701","type":"NDC"}],"standard_charges":[{"gross_charge":23.16,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.85,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080601","type":"CDM"},{"code":"51079080601","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081001","type":"CDM"},{"code":"51079081001","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081201","type":"CDM"},{"code":"51079081201","type":"NDC"}],"standard_charges":[{"gross_charge":29.48,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.72,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081801","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"51079081801","type":"NDC"}],"standard_charges":[{"gross_charge":19.4,"discounted_cash":13.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081820","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"51079081820","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082101","type":"CDM"},{"code":"51079082101","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082120","type":"CDM"},{"code":"51079082120","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086601","type":"CDM"},{"code":"51079086601","type":"NDC"}],"standard_charges":[{"gross_charge":70.57,"discounted_cash":49.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079087001","type":"CDM"},{"code":"51079087001","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088820","type":"CDM"},{"code":"51079088820","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079091701","type":"CDM"},{"code":"51079091701","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079091720","type":"CDM"},{"code":"51079091720","type":"NDC"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":23.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092401","type":"CDM"},{"code":"51079092401","type":"NDC"}],"standard_charges":[{"gross_charge":26.3,"discounted_cash":18.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL CAP ER 12HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079092420","type":"CDM"},{"code":"51079092420","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":20.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093020","type":"CDM"},{"code":"51079093020","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093101","type":"CDM"},{"code":"51079093101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093120","type":"CDM"},{"code":"51079093120","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093801","type":"CDM"},{"code":"51079093801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094301","type":"CDM"},{"code":"51079094301","type":"NDC"}],"standard_charges":[{"gross_charge":17.74,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096001","type":"CDM"},{"code":"51079096001","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096020","type":"CDM"},{"code":"51079096020","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097801","type":"CDM"},{"code":"51079097801","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.76,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098001","type":"CDM"},{"code":"51079098001","type":"NDC"}],"standard_charges":[{"gross_charge":21.44,"discounted_cash":15.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098601","type":"CDM"},{"code":"51079098601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098620","type":"CDM"},{"code":"51079098620","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TISOTUMAB VEDOTIN-TFTV FOR IV SOLUTION 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144000301","type":"CDM"},{"code":"J9273","type":"HCPCS"},{"code":"51144000301","type":"NDC"}],"standard_charges":[{"gross_charge":45655.56,"discounted_cash":31958.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV FOR IV SOLN 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144002001","type":"CDM"},{"code":"J9177","type":"HCPCS"},{"code":"51144002001","type":"NDC"}],"standard_charges":[{"gross_charge":17328.75,"discounted_cash":12130.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV FOR IV SOLN 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51144003001","type":"CDM"},{"code":"J9177","type":"HCPCS"},{"code":"51144003001","type":"NDC"}],"standard_charges":[{"gross_charge":25993.06,"discounted_cash":18195.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":55070.69,"discounted_cash":38549.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224001210","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"51224001210","type":"NDC"}],"standard_charges":[{"gross_charge":3387.93,"discounted_cash":2371.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2553.96,"discounted_cash":1787.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001301","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001325","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001325","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SOLIFENACIN SUCCINATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51248015001","type":"CDM"},{"code":"51248015001","type":"NDC"}],"standard_charges":[{"gross_charge":114.83,"discounted_cash":80.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293081101","type":"CDM"},{"code":"51293081101","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51525011201","type":"CDM"},{"code":"51525011201","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL (BULK) POWDER","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx51552010604","type":"CDM"},{"code":"51552010604","type":"NDC"}],"standard_charges":[{"gross_charge":168.9,"discounted_cash":118.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx51672125903","type":"CDM"},{"code":"51672125903","type":"NDC"}],"standard_charges":[{"gross_charge":139.17,"discounted_cash":97.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOCINONIDE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672126401","type":"CDM"},{"code":"51672126401","type":"NDC"}],"standard_charges":[{"gross_charge":81.57,"discounted_cash":57.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":51.27,"discounted_cash":35.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":126.67,"discounted_cash":88.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE VAGINAL CREAM 1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672200306","type":"CDM"},{"code":"51672200306","type":"NDC"}],"standard_charges":[{"gross_charge":22.14,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672201302","type":"CDM"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":14.31,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211500","type":"CDM"},{"code":"51672211500","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211502","type":"CDM"},{"code":"51672211502","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211600","type":"CDM"},{"code":"51672211600","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORATADINE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51672213108","type":"CDM"},{"code":"51672213108","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400101","type":"CDM"},{"code":"51672400101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400201","type":"CDM"},{"code":"51672400201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402504","type":"CDM"},{"code":"51672402504","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672404801","type":"CDM"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":176.5,"discounted_cash":123.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51672406901","type":"CDM"},{"code":"51672406901","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51672406902","type":"CDM"},{"code":"51672406902","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413001","type":"CDM"},{"code":"51672413001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413101","type":"CDM"},{"code":"51672413101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672413304","type":"CDM"},{"code":"51672413304","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx51754200104","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754200104","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500101","type":"CDM"},{"code":"51754500101","type":"NDC"}],"standard_charges":[{"gross_charge":44.28,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500104","type":"CDM"},{"code":"51754500104","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51754501201","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754501201","type":"NDC"}],"standard_charges":[{"gross_charge":48.93,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx51754501204","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"51754501204","type":"NDC"}],"standard_charges":[{"gross_charge":46.65,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001201","type":"CDM"},{"code":"51801001201","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001230","type":"CDM"},{"code":"51801001230","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862002560","type":"CDM"},{"code":"51862002560","type":"NDC"}],"standard_charges":[{"gross_charge":70.53,"discounted_cash":49.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":225.45,"discounted_cash":157.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 25 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991000633","type":"CDM"},{"code":"51991000633","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":11.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014417","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"gross_charge":132.22,"discounted_cash":92.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014499","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":103.57,"discounted_cash":72.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991029201","type":"CDM"},{"code":"51991029201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991031233","type":"CDM"},{"code":"51991031233","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991036378","type":"CDM"},{"code":"51991036378","type":"NDC"}],"standard_charges":[{"gross_charge":61.57,"discounted_cash":43.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991036399","type":"CDM"},{"code":"51991036399","type":"NDC"}],"standard_charges":[{"gross_charge":22.59,"discounted_cash":15.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LETROZOLE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991075933","type":"CDM"},{"code":"51991075933","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991090701","type":"CDM"},{"code":"51991090701","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098317","type":"CDM"},{"code":"51991098317","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098399","type":"CDM"},{"code":"51991098399","type":"NDC"}],"standard_charges":[{"gross_charge":65.73,"discounted_cash":46.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":396.37,"discounted_cash":277.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THEOPHYLLINE CAP ER 24HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52244010010","type":"CDM"},{"code":"52244010010","type":"NDC"}],"standard_charges":[{"gross_charge":31.68,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268010001","type":"CDM"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":165.39,"discounted_cash":115.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52343016201","type":"CDM"},{"code":"52343016201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.3,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817031910","type":"CDM"},{"code":"52817031910","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUININE SULFATE CAP 324 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53489070007","type":"CDM"},{"code":"53489070007","type":"NDC"}],"standard_charges":[{"gross_charge":63.23,"discounted_cash":44.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746010901","type":"CDM"},{"code":"53746010901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746027201","type":"CDM"},{"code":"53746027201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746044201","type":"CDM"},{"code":"53746044201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746052101","type":"CDM"},{"code":"53746052101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746064101","type":"CDM"},{"code":"53746064101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746071101","type":"CDM"},{"code":"53746071101","type":"NDC"}],"standard_charges":[{"gross_charge":16.66,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746074501","type":"CDM"},{"code":"53746074501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx54288010301","type":"CDM"},{"code":"54288010301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3336.66,"discounted_cash":2335.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3527.61,"discounted_cash":2469.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629071101","type":"CDM"},{"code":"54629071101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS LIQUID","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx54629080098","type":"CDM"},{"code":"54629080098","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx54838000650","type":"CDM"},{"code":"54838000650","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx54838050140","type":"CDM"},{"code":"54838050140","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.27,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":27.3,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111014571","type":"CDM"},{"code":"55111014571","type":"NDC"}],"standard_charges":[{"gross_charge":19.31,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111019690","type":"CDM"},{"code":"55111019690","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111025960","type":"CDM"},{"code":"55111025960","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026279","type":"CDM"},{"code":"55111026279","type":"NDC"}],"standard_charges":[{"gross_charge":37.03,"discounted_cash":25.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026281","type":"CDM"},{"code":"55111026281","type":"NDC"}],"standard_charges":[{"gross_charge":21.97,"discounted_cash":15.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026379","type":"CDM"},{"code":"55111026379","type":"NDC"}],"standard_charges":[{"gross_charge":72.53,"discounted_cash":50.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026381","type":"CDM"},{"code":"55111026381","type":"NDC"}],"standard_charges":[{"gross_charge":25.65,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111028050","type":"CDM"},{"code":"55111028050","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111029209","type":"CDM"},{"code":"55111029209","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111032101","type":"CDM"},{"code":"55111032101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067802","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":63.93,"discounted_cash":44.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067811","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067811","type":"NDC"}],"standard_charges":[{"gross_charge":83.13,"discounted_cash":58.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55111069407","type":"CDM"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":53.84,"discounted_cash":37.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111073001","type":"CDM"},{"code":"55111073001","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SACITUZUMAB GOVITECAN-HZIY FOR IV SOLN 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55135013201","type":"CDM"},{"code":"J9317","type":"HCPCS"},{"code":"55135013201","type":"NDC"}],"standard_charges":[{"gross_charge":15504.15,"discounted_cash":10852.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011420","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011620","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011720","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011930","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx55150012030","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx55150012150","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55150015520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015520","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016205","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016300","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016330","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016830","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017030","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017110","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017230","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017230","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150017410","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017705","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018301","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"55150018301","type":"NDC"}],"standard_charges":[{"gross_charge":116.55,"discounted_cash":81.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018310","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":65.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018810","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"55150018810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx55150019301","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301","type":"NDC"}],"standard_charges":[{"gross_charge":148.12,"discounted_cash":103.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150020120","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"55150020120","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020200","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020200","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020210","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL INJ 200 MCG/2ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 400 MCG/4ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 1000 MCG/10ML (FOR IV INFUSION)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150020902","type":"CDM"},{"code":"55150020902","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150022310","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"55150022310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023200","type":"NDC"}],"standard_charges":[{"gross_charge":274.94,"discounted_cash":192.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":66.47,"discounted_cash":46.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023501","type":"CDM"},{"code":"55150023501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023510","type":"CDM"},{"code":"55150023510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx55150024005","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"55150024005","type":"NDC"}],"standard_charges":[{"gross_charge":1711.93,"discounted_cash":1198.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx55150024251","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"55150024251","type":"NDC"}],"standard_charges":[{"gross_charge":51.06,"discounted_cash":35.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025110","type":"CDM"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025220","type":"CDM"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025410","type":"CDM"},{"code":"55150025410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025520","type":"CDM"},{"code":"55150025520","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150026705","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"55150026705","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150027199","type":"CDM"},{"code":"J9071","type":"HCPCS"},{"code":"55150027199","type":"NDC"}],"standard_charges":[{"gross_charge":1268.32,"discounted_cash":887.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":251.02,"discounted_cash":175.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150028401","type":"CDM"},{"code":"55150028401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150028410","type":"CDM"},{"code":"55150028410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":341.59,"discounted_cash":239.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029710","type":"CDM"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":120.84,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"55150030801","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":78.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx55150032801","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150032801","type":"NDC"}],"standard_charges":[{"gross_charge":74.69,"discounted_cash":52.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx55150032810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150032810","type":"NDC"}],"standard_charges":[{"gross_charge":47.55,"discounted_cash":33.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150033101","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"55150033101","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx55150033501","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":303.41,"discounted_cash":212.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150035301","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"55150035301","type":"NDC"}],"standard_charges":[{"gross_charge":119.64,"discounted_cash":83.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHOTERICIN B LIPOSOME IV FOR SUSP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150036501","type":"CDM"},{"code":"J0289","type":"HCPCS"},{"code":"55150036501","type":"NDC"}],"standard_charges":[{"gross_charge":1024.31,"discounted_cash":717.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx55150038001","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"55150038001","type":"NDC"}],"standard_charges":[{"gross_charge":1171.36,"discounted_cash":819.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040101","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040125","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040201","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150040225","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042701","type":"CDM"},{"code":"55150042701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042710","type":"CDM"},{"code":"55150042710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150043701","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"55150043701","type":"NDC"}],"standard_charges":[{"gross_charge":1124.01,"discounted_cash":786.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043801","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043810","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150043901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043901","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150043910","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043910","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEMIN FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55292070254","type":"CDM"},{"code":"J1640","type":"HCPCS"},{"code":"55292070254","type":"NDC"}],"standard_charges":[{"gross_charge":37812.43,"discounted_cash":26468.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEMIN FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55292070255","type":"CDM"},{"code":"J1640","type":"HCPCS"},{"code":"55292070255","type":"NDC"}],"standard_charges":[{"gross_charge":37812.43,"discounted_cash":26468.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 60 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx55513002301","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513002301","type":"NDC"}],"standard_charges":[{"gross_charge":3607.54,"discounted_cash":2525.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 60 MCG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx55513002304","type":"CDM"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"gross_charge":3712.36,"discounted_cash":2598.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":140.97,"discounted_cash":98.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9334.1,"discounted_cash":6533.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEZEPELUMAB-EKKO SUBCUTANEOUS SOLN PREF SYR 210 MG/1.91ML","drug_information":{"unit":1.91,"type":"ML"},"code_information":[{"code":"Rx55513011201","type":"CDM"},{"code":"J2356","type":"HCPCS"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":19081.92,"discounted_cash":13357.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRASTUZUMAB-ANNS FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513013201","type":"CDM"},{"code":"Q5117","type":"HCPCS"},{"code":"55513013201","type":"NDC"}],"standard_charges":[{"gross_charge":21208.77,"discounted_cash":14846.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24444.55,"discounted_cash":17111.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx55513020601","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":5628.23,"discounted_cash":3939.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-AWWB IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx55513020701","type":"CDM"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":15543.25,"discounted_cash":10880.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML)","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55513020991","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"gross_charge":4248.19,"discounted_cash":2973.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":12024.12,"discounted_cash":8416.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022301","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":6012.14,"discounted_cash":4208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITUXIMAB-ARRX IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55513022401","type":"CDM"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":5900.03,"discounted_cash":4130.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RITUXIMAB-ARRX IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx55513032601","type":"CDM"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":20367.62,"discounted_cash":14257.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7546.49,"discounted_cash":5282.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071021","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":7548.95,"discounted_cash":5284.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":13884.47,"discounted_cash":9719.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11482.13,"discounted_cash":8037.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11482.13,"discounted_cash":8037.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513099801","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513099801","type":"NDC"}],"standard_charges":[{"gross_charge":11482.13,"discounted_cash":8037.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513099802","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":11482.13,"discounted_cash":8037.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEGARELIX ACETATE FOR INJ 80 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566830200","type":"CDM"},{"code":"J9155","type":"HCPCS"},{"code":"55566830200","type":"NDC"}],"standard_charges":[{"gross_charge":5245.61,"discounted_cash":3671.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEGARELIX ACETATE FOR INJ 80 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55566830301","type":"CDM"},{"code":"J9155","type":"HCPCS"},{"code":"55566830301","type":"NDC"}],"standard_charges":[{"gross_charge":5202.39,"discounted_cash":3641.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6272.79,"discounted_cash":4390.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENTAFLUOROPROPANE-TETRAFLUOROETHANE AERO SPRAY","drug_information":{"unit":115.0,"type":"ML"},"code_information":[{"code":"Rx56331000614","type":"CDM"},{"code":"56331000614","type":"NDC"}],"standard_charges":[{"gross_charge":126.27,"discounted_cash":88.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENTAFLUOROPROPANE-TETRAFLUOROETHANE AERO SPRAY","drug_information":{"unit":115.0,"type":"ML"},"code_information":[{"code":"Rx56331000615","type":"CDM"},{"code":"56331000615","type":"NDC"}],"standard_charges":[{"gross_charge":126.27,"discounted_cash":88.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237000511","type":"CDM"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":12.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001830","type":"CDM"},{"code":"57237001830","type":"NDC"}],"standard_charges":[{"gross_charge":15.64,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001890","type":"CDM"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237003001","type":"CDM"},{"code":"57237003001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237009960","type":"CDM"},{"code":"57237009960","type":"NDC"}],"standard_charges":[{"gross_charge":17.96,"discounted_cash":12.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.28,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017201","type":"CDM"},{"code":"57237017201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017301","type":"CDM"},{"code":"57237017301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237018090","type":"CDM"},{"code":"57237018090","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 15 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237021930","type":"CDM"},{"code":"57237021930","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx57237031403","type":"CDM"},{"code":"57237031403","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx57237031431","type":"CDM"},{"code":"57237031431","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57237031915","type":"CDM"},{"code":"57237031915","type":"NDC"}],"standard_charges":[{"gross_charge":14.82,"discounted_cash":10.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57237031952","type":"CDM"},{"code":"57237031952","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE POLACRILEX LOZENGE 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237032072","type":"CDM"},{"code":"57237032072","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022888","type":"CDM"},{"code":"57664022888","type":"NDC"}],"standard_charges":[{"gross_charge":15.06,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664037708","type":"CDM"},{"code":"57664037708","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068331","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068331","type":"NDC"}],"standard_charges":[{"gross_charge":168.49,"discounted_cash":117.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068357","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":63.82,"discounted_cash":44.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx57826042002","type":"CDM"},{"code":"57826042002","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4698.35,"discounted_cash":3288.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":9258.8,"discounted_cash":6481.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"USTEKINUMAB SOLN PREFILLED SYRINGE 90 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx57894006103","type":"CDM"},{"code":"J3357","type":"HCPCS"},{"code":"57894006103","type":"NDC"}],"standard_charges":[{"gross_charge":117301.8,"discounted_cash":82111.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3800.25,"discounted_cash":2660.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GOLIMUMAB IV SOLN 50 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx57894035001","type":"CDM"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":8040.46,"discounted_cash":5628.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIVANTAMAB-VMJW IV SOLN 350 MG/7ML","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx57894050101","type":"CDM"},{"code":"J9061","type":"HCPCS"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":23483.43,"discounted_cash":16438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ INJ 1800-30000 MG-UNIT/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx57894050301","type":"CDM"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":64891.77,"discounted_cash":45424.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx57894050505","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050505","type":"NDC"}],"standard_charges":[{"gross_charge":5728.45,"discounted_cash":4009.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DARATUMUMAB IV SOLN 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894050520","type":"CDM"},{"code":"J9145","type":"HCPCS"},{"code":"57894050520","type":"NDC"}],"standard_charges":[{"gross_charge":19043.54,"discounted_cash":13330.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUSELKUMAB IV SOLN 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx57894065001","type":"CDM"},{"code":"J1628","type":"HCPCS"},{"code":"57894065001","type":"NDC"}],"standard_charges":[{"gross_charge":63595.12,"discounted_cash":44516.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896022101","type":"CDM"},{"code":"57896022101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896045501","type":"CDM"},{"code":"57896045501","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896045506","type":"CDM"},{"code":"57896045506","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896045806","type":"CDM"},{"code":"57896045806","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896063412","type":"CDM"},{"code":"57896063412","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896079101","type":"CDM"},{"code":"57896079101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896084401","type":"CDM"},{"code":"57896084401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896090101","type":"CDM"},{"code":"57896090101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896092101","type":"CDM"},{"code":"57896092101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896094101","type":"CDM"},{"code":"57896094101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4023.87,"discounted_cash":2816.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082101","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082101","type":"NDC"}],"standard_charges":[{"gross_charge":592.55,"discounted_cash":414.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 20 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx58160082111","type":"CDM"},{"code":"90746","type":"HCPCS"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"gross_charge":470.02,"discounted_cash":329.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084201","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084201","type":"NDC"}],"standard_charges":[{"gross_charge":459.89,"discounted_cash":321.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084211","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084211","type":"NDC"}],"standard_charges":[{"gross_charge":459.89,"discounted_cash":321.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":427.27,"discounted_cash":299.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx58160084252","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":380.94,"discounted_cash":266.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THYROTROPIN ALFA FOR INJ 0.9 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468003001","type":"CDM"},{"code":"J3240","type":"HCPCS"},{"code":"58468003001","type":"NDC"}],"standard_charges":[{"gross_charge":8877.12,"discounted_cash":6213.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":7792.38,"discounted_cash":5454.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTI-THYMOCYTE GLOBULIN FOR IV SOLN 25 MG (LYMPHOCYTE IG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468008001","type":"CDM"},{"code":"J7511","type":"HCPCS"},{"code":"58468008001","type":"NDC"}],"standard_charges":[{"gross_charge":4037.52,"discounted_cash":2826.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALGLUCOSIDASE ALFA FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58468016001","type":"CDM"},{"code":"J0221","type":"HCPCS"},{"code":"58468016001","type":"NDC"}],"standard_charges":[{"gross_charge":3652.73,"discounted_cash":2556.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALEMTUZUMAB IV INJ 12 MG/1.2ML (10 MG/ML)","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx58468020001","type":"CDM"},{"code":"J0202","type":"HCPCS"},{"code":"58468020001","type":"NDC"}],"standard_charges":[{"gross_charge":93369.15,"discounted_cash":65358.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx58657050016","type":"CDM"},{"code":"58657050016","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58657093001","type":"CDM"},{"code":"58657093001","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":14.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx58914008052","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"58914008052","type":"NDC"}],"standard_charges":[{"gross_charge":819.79,"discounted_cash":573.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":164.34,"discounted_cash":115.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041010","type":"CDM"},{"code":"59011041010","type":"NDC"}],"standard_charges":[{"gross_charge":35.2,"discounted_cash":24.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":35.77,"discounted_cash":25.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":70.07,"discounted_cash":49.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":81.58,"discounted_cash":57.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1177.78,"discounted_cash":824.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN W/ BENOXINATE OPHTH SOLN 0.25-0.4%","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx59390021805","type":"CDM"},{"code":"59390021805","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LUSPATERCEPT-AAMT FOR SUBCUTANEOUS INJ 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572071101","type":"CDM"},{"code":"J0896","type":"HCPCS"},{"code":"59572071101","type":"NDC"}],"standard_charges":[{"gross_charge":17614.12,"discounted_cash":12329.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LUSPATERCEPT-AAMT FOR SUBCUTANEOUS INJ 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59572077501","type":"CDM"},{"code":"J0896","type":"HCPCS"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"gross_charge":52842.12,"discounted_cash":36989.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651025601","type":"CDM"},{"code":"59651025601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651033201","type":"CDM"},{"code":"59651033201","type":"NDC"}],"standard_charges":[{"gross_charge":155.13,"discounted_cash":108.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651045601","type":"CDM"},{"code":"59651045601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651048801","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59651048801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651056501","type":"CDM"},{"code":"59651056501","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651072201","type":"CDM"},{"code":"59651072201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRABECTEDIN FOR INJ 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59676061001","type":"CDM"},{"code":"J9352","type":"HCPCS"},{"code":"59676061001","type":"NDC"}],"standard_charges":[{"gross_charge":22759.51,"discounted_cash":15931.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746017506","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59746017506","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038306","type":"CDM"},{"code":"59746038306","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762003802","type":"CDM"},{"code":"59762003802","type":"NDC"}],"standard_charges":[{"gross_charge":33.19,"discounted_cash":23.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.42,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx59762033302","type":"CDM"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762106101","type":"CDM"},{"code":"59762106101","type":"NDC"}],"standard_charges":[{"gross_charge":15.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762134401","type":"CDM"},{"code":"59762134401","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":108.78,"discounted_cash":76.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500001","type":"CDM"},{"code":"59762500001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN ORAL SOLN 250 MG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx59762505007","type":"CDM"},{"code":"59762505007","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60219126401","type":"CDM"},{"code":"60219126401","type":"NDC"}],"standard_charges":[{"gross_charge":75.85,"discounted_cash":53.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60219174903","type":"CDM"},{"code":"60219174903","type":"NDC"}],"standard_charges":[{"gross_charge":386.13,"discounted_cash":270.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000615","type":"CDM"},{"code":"60258000615","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM NITRITE INJ 30 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60267031110","type":"CDM"},{"code":"60267031110","type":"NDC"}],"standard_charges":[{"gross_charge":301.43,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432060616","type":"CDM"},{"code":"60432060616","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SELEGILINE HCL CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505005501","type":"CDM"},{"code":"60505005501","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505008302","type":"CDM"},{"code":"60505008302","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505015801","type":"CDM"},{"code":"60505015801","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505056000","type":"CDM"},{"code":"60505056000","type":"NDC"}],"standard_charges":[{"gross_charge":179.14,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60505082601","type":"CDM"},{"code":"60505082601","type":"NDC"}],"standard_charges":[{"gross_charge":295.29,"discounted_cash":206.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":34.36,"discounted_cash":24.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505311000","type":"CDM"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMCICLOVIR TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505324603","type":"CDM"},{"code":"60505324603","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SELEGILINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505343803","type":"CDM"},{"code":"60505343803","type":"NDC"}],"standard_charges":[{"gross_charge":17.59,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRASUGREL HCL TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505464203","type":"CDM"},{"code":"60505464203","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505612801","type":"CDM"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505613206","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614200","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505614200","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614205","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614500","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614500","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614504","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614504","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx60505615704","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx60505615900","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615900","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx60505615904","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619600","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"gross_charge":627.02,"discounted_cash":438.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619604","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":162.24,"discounted_cash":113.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623105","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623600","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"60505623600","type":"NDC"}],"standard_charges":[{"gross_charge":83.64,"discounted_cash":58.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEFEROXAMINE MESYLATE FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623606","type":"CDM"},{"code":"J0895","type":"HCPCS"},{"code":"60505623606","type":"NDC"}],"standard_charges":[{"gross_charge":82.99,"discounted_cash":58.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx60505628206","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"60505628206","type":"NDC"}],"standard_charges":[{"gross_charge":413.17,"discounted_cash":289.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700800","type":"CDM"},{"code":"60505700800","type":"NDC"}],"standard_charges":[{"gross_charge":68.2,"discounted_cash":47.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706100","type":"CDM"},{"code":"60505706100","type":"NDC"}],"standard_charges":[{"gross_charge":8.13,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706200","type":"CDM"},{"code":"60505706200","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706300","type":"CDM"},{"code":"60505706300","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706400","type":"CDM"},{"code":"60505706400","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706500","type":"CDM"},{"code":"60505706500","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708302","type":"CDM"},{"code":"60505708302","type":"NDC"}],"standard_charges":[{"gross_charge":112.2,"discounted_cash":78.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708400","type":"CDM"},{"code":"60505708400","type":"NDC"}],"standard_charges":[{"gross_charge":84.69,"discounted_cash":59.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708402","type":"CDM"},{"code":"60505708402","type":"NDC"}],"standard_charges":[{"gross_charge":151.86,"discounted_cash":106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZOCAINE DENTAL GEL 20%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60640880001","type":"CDM"},{"code":"60640880001","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687010411","type":"CDM"},{"code":"60687010411","type":"NDC"}],"standard_charges":[{"gross_charge":36.43,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687010421","type":"CDM"},{"code":"60687010421","type":"NDC"}],"standard_charges":[{"gross_charge":62.79,"discounted_cash":43.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011211","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"60687011211","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011221","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"60687011221","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011311","type":"CDM"},{"code":"60687011311","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012201","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012211","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 850 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014311","type":"CDM"},{"code":"60687014311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014501","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014511","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015211","type":"CDM"},{"code":"60687015211","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015501","type":"CDM"},{"code":"60687015501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015511","type":"CDM"},{"code":"60687015511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.89,"discounted_cash":13.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015695","type":"CDM"},{"code":"60687015695","type":"NDC"}],"standard_charges":[{"gross_charge":18.91,"discounted_cash":13.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016301","type":"CDM"},{"code":"60687016301","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016311","type":"CDM"},{"code":"60687016311","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687017311","type":"CDM"},{"code":"60687017311","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687017357","type":"CDM"},{"code":"60687017357","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687018811","type":"CDM"},{"code":"60687018811","type":"NDC"}],"standard_charges":[{"gross_charge":30.08,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENTACAPONE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687018821","type":"CDM"},{"code":"60687018821","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":22.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.08,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020611","type":"CDM"},{"code":"60687020611","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021111","type":"CDM"},{"code":"60687021111","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.12,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.04,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021511","type":"CDM"},{"code":"60687021511","type":"NDC"}],"standard_charges":[{"gross_charge":22.67,"discounted_cash":15.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021711","type":"CDM"},{"code":"60687021711","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022401","type":"CDM"},{"code":"60687022401","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022411","type":"CDM"},{"code":"60687022411","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":24.9,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022611","type":"CDM"},{"code":"60687022611","type":"NDC"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022901","type":"CDM"},{"code":"60687022901","type":"NDC"}],"standard_charges":[{"gross_charge":16.88,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022911","type":"CDM"},{"code":"60687022911","type":"NDC"}],"standard_charges":[{"gross_charge":16.35,"discounted_cash":11.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687023001","type":"CDM"},{"code":"60687023001","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687023111","type":"CDM"},{"code":"60687023111","type":"NDC"}],"standard_charges":[{"gross_charge":15.22,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024201","type":"CDM"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024211","type":"CDM"},{"code":"60687024211","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024511","type":"CDM"},{"code":"60687024511","type":"NDC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024565","type":"CDM"},{"code":"60687024565","type":"NDC"}],"standard_charges":[{"gross_charge":16.54,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.92,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687027211","type":"CDM"},{"code":"60687027211","type":"NDC"}],"standard_charges":[{"gross_charge":28.91,"discounted_cash":20.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":31.28,"discounted_cash":21.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.8,"discounted_cash":11.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.42,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029311","type":"CDM"},{"code":"60687029311","type":"NDC"}],"standard_charges":[{"gross_charge":15.97,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030295","type":"CDM"},{"code":"60687030295","type":"NDC"}],"standard_charges":[{"gross_charge":27.39,"discounted_cash":19.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030301","type":"CDM"},{"code":"60687030301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030311","type":"CDM"},{"code":"60687030311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031711","type":"CDM"},{"code":"60687031711","type":"NDC"}],"standard_charges":[{"gross_charge":21.74,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031725","type":"CDM"},{"code":"60687031725","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031911","type":"CDM"},{"code":"60687031911","type":"NDC"}],"standard_charges":[{"gross_charge":62.71,"discounted_cash":43.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687031921","type":"CDM"},{"code":"60687031921","type":"NDC"}],"standard_charges":[{"gross_charge":65.69,"discounted_cash":45.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032511","type":"CDM"},{"code":"60687032511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033301","type":"CDM"},{"code":"60687033301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033311","type":"CDM"},{"code":"60687033311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.41,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034511","type":"CDM"},{"code":"60687034511","type":"NDC"}],"standard_charges":[{"gross_charge":17.41,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687035711","type":"CDM"},{"code":"60687035711","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036901","type":"CDM"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036911","type":"CDM"},{"code":"60687036911","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037501","type":"CDM"},{"code":"60687037501","type":"NDC"}],"standard_charges":[{"gross_charge":32.89,"discounted_cash":23.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.77,"discounted_cash":26.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037521","type":"CDM"},{"code":"60687037521","type":"NDC"}],"standard_charges":[{"gross_charge":70.42,"discounted_cash":49.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037701","type":"CDM"},{"code":"60687037701","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":10.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037711","type":"CDM"},{"code":"60687037711","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038001","type":"CDM"},{"code":"60687038001","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038011","type":"CDM"},{"code":"60687038011","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038801","type":"CDM"},{"code":"60687038801","type":"NDC"}],"standard_charges":[{"gross_charge":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038811","type":"CDM"},{"code":"60687038811","type":"NDC"}],"standard_charges":[{"gross_charge":15.54,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038911","type":"CDM"},{"code":"60687038911","type":"NDC"}],"standard_charges":[{"gross_charge":68.01,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038921","type":"CDM"},{"code":"60687038921","type":"NDC"}],"standard_charges":[{"gross_charge":73.94,"discounted_cash":51.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687039479","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"60687039479","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687039483","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx60687039579","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"60687039579","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx60687039583","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039801","type":"CDM"},{"code":"60687039801","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039811","type":"CDM"},{"code":"60687039811","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040101","type":"CDM"},{"code":"60687040101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040111","type":"CDM"},{"code":"60687040111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040211","type":"CDM"},{"code":"60687040211","type":"NDC"}],"standard_charges":[{"gross_charge":18.58,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040265","type":"CDM"},{"code":"60687040265","type":"NDC"}],"standard_charges":[{"gross_charge":15.98,"discounted_cash":11.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040579","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040579","type":"NDC"}],"standard_charges":[{"gross_charge":16.49,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040583","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687040640","type":"CDM"},{"code":"60687040640","type":"NDC"}],"standard_charges":[{"gross_charge":83.29,"discounted_cash":58.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687040677","type":"CDM"},{"code":"60687040677","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":20.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESALAMINE TAB DELAYED RELEASE 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040825","type":"CDM"},{"code":"60687040825","type":"NDC"}],"standard_charges":[{"gross_charge":128.15,"discounted_cash":89.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MESALAMINE TAB DELAYED RELEASE 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040895","type":"CDM"},{"code":"60687040895","type":"NDC"}],"standard_charges":[{"gross_charge":88.8,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041311","type":"CDM"},{"code":"60687041311","type":"NDC"}],"standard_charges":[{"gross_charge":20.54,"discounted_cash":14.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 100 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041365","type":"CDM"},{"code":"60687041365","type":"NDC"}],"standard_charges":[{"gross_charge":16.44,"discounted_cash":11.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041611","type":"CDM"},{"code":"60687041611","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041621","type":"CDM"},{"code":"60687041621","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041801","type":"CDM"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":11.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041811","type":"CDM"},{"code":"60687041811","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042411","type":"CDM"},{"code":"60687042411","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042501","type":"CDM"},{"code":"60687042501","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042511","type":"CDM"},{"code":"60687042511","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":13.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042811","type":"CDM"},{"code":"60687042811","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":12.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687042865","type":"CDM"},{"code":"60687042865","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60687042945","type":"CDM"},{"code":"60687042945","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60687042976","type":"CDM"},{"code":"60687042976","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043011","type":"CDM"},{"code":"60687043011","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043065","type":"CDM"},{"code":"60687043065","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043301","type":"CDM"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"gross_charge":15.85,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043311","type":"CDM"},{"code":"60687043311","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043711","type":"CDM"},{"code":"60687043711","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043901","type":"CDM"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043911","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":15.22,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044301","type":"CDM"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044311","type":"CDM"},{"code":"60687044311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044601","type":"CDM"},{"code":"60687044601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044611","type":"CDM"},{"code":"60687044611","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044711","type":"CDM"},{"code":"60687044711","type":"NDC"}],"standard_charges":[{"gross_charge":21.02,"discounted_cash":14.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045301","type":"CDM"},{"code":"60687045301","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045311","type":"CDM"},{"code":"60687045311","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045401","type":"CDM"},{"code":"60687045401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAZODONE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045411","type":"CDM"},{"code":"60687045411","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045701","type":"CDM"},{"code":"60687045701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045711","type":"CDM"},{"code":"60687045711","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687046401","type":"CDM"},{"code":"60687046401","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687046411","type":"CDM"},{"code":"60687046411","type":"NDC"}],"standard_charges":[{"gross_charge":15.62,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687046511","type":"CDM"},{"code":"60687046511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047301","type":"CDM"},{"code":"60687047301","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047311","type":"CDM"},{"code":"60687047311","type":"NDC"}],"standard_charges":[{"gross_charge":16.83,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 75 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047501","type":"CDM"},{"code":"60687047501","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047901","type":"CDM"},{"code":"60687047901","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE CHEW TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047911","type":"CDM"},{"code":"60687047911","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048111","type":"CDM"},{"code":"60687048111","type":"NDC"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048121","type":"CDM"},{"code":"60687048121","type":"NDC"}],"standard_charges":[{"gross_charge":24.2,"discounted_cash":16.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048401","type":"CDM"},{"code":"60687048401","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":11.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048411","type":"CDM"},{"code":"60687048411","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048701","type":"CDM"},{"code":"60687048701","type":"NDC"}],"standard_charges":[{"gross_charge":16.93,"discounted_cash":11.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048711","type":"CDM"},{"code":"60687048711","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049111","type":"CDM"},{"code":"60687049111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049211","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"60687049211","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":18.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049221","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"60687049221","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049501","type":"CDM"},{"code":"60687049501","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":11.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049511","type":"CDM"},{"code":"60687049511","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687049711","type":"CDM"},{"code":"60687049711","type":"NDC"}],"standard_charges":[{"gross_charge":16.14,"discounted_cash":11.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050601","type":"CDM"},{"code":"60687050601","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":11.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050611","type":"CDM"},{"code":"60687050611","type":"NDC"}],"standard_charges":[{"gross_charge":20.33,"discounted_cash":14.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050801","type":"CDM"},{"code":"60687050801","type":"NDC"}],"standard_charges":[{"gross_charge":16.76,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050811","type":"CDM"},{"code":"60687050811","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687052479","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"60687052479","type":"NDC"}],"standard_charges":[{"gross_charge":35.54,"discounted_cash":24.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687052483","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":35.61,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687052511","type":"CDM"},{"code":"60687052511","type":"NDC"}],"standard_charges":[{"gross_charge":110.86,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687052521","type":"CDM"},{"code":"60687052521","type":"NDC"}],"standard_charges":[{"gross_charge":112.27,"discounted_cash":78.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687052801","type":"CDM"},{"code":"60687052801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687052811","type":"CDM"},{"code":"60687052811","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054401","type":"CDM"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054411","type":"CDM"},{"code":"60687054411","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054911","type":"CDM"},{"code":"60687054911","type":"NDC"}],"standard_charges":[{"gross_charge":20.13,"discounted_cash":14.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054921","type":"CDM"},{"code":"60687054921","type":"NDC"}],"standard_charges":[{"gross_charge":20.73,"discounted_cash":14.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.71,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055011","type":"CDM"},{"code":"60687055011","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055801","type":"CDM"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055811","type":"CDM"},{"code":"60687055811","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055901","type":"CDM"},{"code":"60687055901","type":"NDC"}],"standard_charges":[{"gross_charge":15.39,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055911","type":"CDM"},{"code":"60687055911","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056201","type":"CDM"},{"code":"60687056201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056211","type":"CDM"},{"code":"60687056211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL LIQD 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687056640","type":"CDM"},{"code":"60687056640","type":"NDC"}],"standard_charges":[{"gross_charge":22.63,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL LIQD 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687056686","type":"CDM"},{"code":"60687056686","type":"NDC"}],"standard_charges":[{"gross_charge":22.99,"discounted_cash":16.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056801","type":"CDM"},{"code":"60687056801","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056811","type":"CDM"},{"code":"60687056811","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057511","type":"CDM"},{"code":"60687057511","type":"NDC"}],"standard_charges":[{"gross_charge":19.1,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057521","type":"CDM"},{"code":"60687057521","type":"NDC"}],"standard_charges":[{"gross_charge":28.57,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687057640","type":"CDM"},{"code":"60687057640","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":19.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx60687057686","type":"CDM"},{"code":"60687057686","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":19.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057901","type":"CDM"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057911","type":"CDM"},{"code":"60687057911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058001","type":"CDM"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058011","type":"CDM"},{"code":"60687058011","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058111","type":"CDM"},{"code":"60687058111","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058121","type":"CDM"},{"code":"60687058121","type":"NDC"}],"standard_charges":[{"gross_charge":17.35,"discounted_cash":12.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058201","type":"CDM"},{"code":"60687058201","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":14.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058211","type":"CDM"},{"code":"60687058211","type":"NDC"}],"standard_charges":[{"gross_charge":20.03,"discounted_cash":14.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058411","type":"CDM"},{"code":"60687058411","type":"NDC"}],"standard_charges":[{"gross_charge":27.15,"discounted_cash":19.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058421","type":"CDM"},{"code":"60687058421","type":"NDC"}],"standard_charges":[{"gross_charge":25.28,"discounted_cash":17.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058601","type":"CDM"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":15.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058611","type":"CDM"},{"code":"60687058611","type":"NDC"}],"standard_charges":[{"gross_charge":17.88,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058701","type":"CDM"},{"code":"60687058701","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058711","type":"CDM"},{"code":"60687058711","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058801","type":"CDM"},{"code":"60687058801","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058811","type":"CDM"},{"code":"60687058811","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":11.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059001","type":"CDM"},{"code":"60687059001","type":"NDC"}],"standard_charges":[{"gross_charge":16.03,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059011","type":"CDM"},{"code":"60687059011","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059101","type":"CDM"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059111","type":"CDM"},{"code":"60687059111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059301","type":"CDM"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059311","type":"CDM"},{"code":"60687059311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060901","type":"CDM"},{"code":"60687060901","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060911","type":"CDM"},{"code":"60687060911","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061211","type":"CDM"},{"code":"60687061211","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALSARTAN TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061221","type":"CDM"},{"code":"60687061221","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":12.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061701","type":"CDM"},{"code":"60687061701","type":"NDC"}],"standard_charges":[{"gross_charge":17.7,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687061711","type":"CDM"},{"code":"60687061711","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062201","type":"CDM"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062211","type":"CDM"},{"code":"60687062211","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062701","type":"CDM"},{"code":"60687062701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062711","type":"CDM"},{"code":"60687062711","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063101","type":"CDM"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063111","type":"CDM"},{"code":"60687063111","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063401","type":"CDM"},{"code":"60687063401","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALSARTAN TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063411","type":"CDM"},{"code":"60687063411","type":"NDC"}],"standard_charges":[{"gross_charge":19.63,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.03,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064011","type":"CDM"},{"code":"60687064011","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065611","type":"CDM"},{"code":"60687065611","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065621","type":"CDM"},{"code":"60687065621","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":11.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066001","type":"CDM"},{"code":"60687066001","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066011","type":"CDM"},{"code":"60687066011","type":"NDC"}],"standard_charges":[{"gross_charge":32.1,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066101","type":"CDM"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066111","type":"CDM"},{"code":"60687066111","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066401","type":"CDM"},{"code":"60687066401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066411","type":"CDM"},{"code":"60687066411","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066901","type":"CDM"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066911","type":"CDM"},{"code":"60687066911","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067211","type":"CDM"},{"code":"60687067211","type":"NDC"}],"standard_charges":[{"gross_charge":21.56,"discounted_cash":15.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067265","type":"CDM"},{"code":"60687067265","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067701","type":"CDM"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067711","type":"CDM"},{"code":"60687067711","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068001","type":"CDM"},{"code":"60687068001","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHIMAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068011","type":"CDM"},{"code":"60687068011","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068101","type":"CDM"},{"code":"60687068101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068111","type":"CDM"},{"code":"60687068111","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069501","type":"CDM"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069511","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069911","type":"CDM"},{"code":"60687069911","type":"NDC"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":20.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069921","type":"CDM"},{"code":"60687069921","type":"NDC"}],"standard_charges":[{"gross_charge":29.43,"discounted_cash":20.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070401","type":"CDM"},{"code":"60687070401","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070411","type":"CDM"},{"code":"60687070411","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070711","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"60687070711","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070765","type":"CDM"},{"code":"Q0177","type":"HCPCS"},{"code":"60687070765","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070901","type":"CDM"},{"code":"60687070901","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070911","type":"CDM"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071011","type":"CDM"},{"code":"60687071011","type":"NDC"}],"standard_charges":[{"gross_charge":25.57,"discounted_cash":17.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071021","type":"CDM"},{"code":"60687071021","type":"NDC"}],"standard_charges":[{"gross_charge":24.88,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx60687071444","type":"CDM"},{"code":"60687071444","type":"NDC"}],"standard_charges":[{"gross_charge":19.69,"discounted_cash":13.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx60687071464","type":"CDM"},{"code":"60687071464","type":"NDC"}],"standard_charges":[{"gross_charge":18.58,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071701","type":"CDM"},{"code":"60687071701","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071711","type":"CDM"},{"code":"60687071711","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072111","type":"CDM"},{"code":"60687072111","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":15.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072121","type":"CDM"},{"code":"60687072121","type":"NDC"}],"standard_charges":[{"gross_charge":22.73,"discounted_cash":15.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072311","type":"CDM"},{"code":"60687072311","type":"NDC"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072321","type":"CDM"},{"code":"60687072321","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":12.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072501","type":"CDM"},{"code":"60687072501","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072511","type":"CDM"},{"code":"60687072511","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072711","type":"CDM"},{"code":"60687072711","type":"NDC"}],"standard_charges":[{"gross_charge":32.13,"discounted_cash":22.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072721","type":"CDM"},{"code":"60687072721","type":"NDC"}],"standard_charges":[{"gross_charge":32.14,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072901","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687072901","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":14.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072911","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687072911","type":"NDC"}],"standard_charges":[{"gross_charge":21.33,"discounted_cash":14.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073001","type":"CDM"},{"code":"60687073001","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073011","type":"CDM"},{"code":"60687073011","type":"NDC"}],"standard_charges":[{"gross_charge":5.24,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073501","type":"CDM"},{"code":"60687073501","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073511","type":"CDM"},{"code":"60687073511","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073609","type":"CDM"},{"code":"60687073609","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073611","type":"CDM"},{"code":"60687073611","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074411","type":"CDM"},{"code":"60687074411","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074421","type":"CDM"},{"code":"60687074421","type":"NDC"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":21.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687077601","type":"CDM"},{"code":"60687077601","type":"NDC"}],"standard_charges":[{"gross_charge":18.07,"discounted_cash":12.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687077611","type":"CDM"},{"code":"60687077611","type":"NDC"}],"standard_charges":[{"gross_charge":24.11,"discounted_cash":16.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079501","type":"CDM"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079511","type":"CDM"},{"code":"60687079511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687081201","type":"CDM"},{"code":"60687081201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687081211","type":"CDM"},{"code":"60687081211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687082201","type":"CDM"},{"code":"60687082201","type":"NDC"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687082211","type":"CDM"},{"code":"60687082211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083601","type":"CDM"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083611","type":"CDM"},{"code":"60687083611","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083801","type":"CDM"},{"code":"60687083801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083811","type":"CDM"},{"code":"60687083811","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687084101","type":"CDM"},{"code":"60687084101","type":"NDC"}],"standard_charges":[{"gross_charge":21.1,"discounted_cash":14.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687084111","type":"CDM"},{"code":"60687084111","type":"NDC"}],"standard_charges":[{"gross_charge":20.25,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687085401","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687085401","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687085411","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687085411","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086001","type":"CDM"},{"code":"60687086001","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086011","type":"CDM"},{"code":"60687086011","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086411","type":"CDM"},{"code":"60687086411","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086421","type":"CDM"},{"code":"60687086421","type":"NDC"}],"standard_charges":[{"gross_charge":24.86,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086501","type":"CDM"},{"code":"60687086501","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086511","type":"CDM"},{"code":"60687086511","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086801","type":"CDM"},{"code":"60687086801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687086811","type":"CDM"},{"code":"60687086811","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":57.31,"discounted_cash":40.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080205","type":"CDM"},{"code":"60758080205","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROMETHOLONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758088005","type":"CDM"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":625.86,"discounted_cash":438.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THROMBIN FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60793021505","type":"CDM"},{"code":"60793021505","type":"NDC"}],"standard_charges":[{"gross_charge":244.74,"discounted_cash":171.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":562.43,"discounted_cash":393.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THROMBIN FOR SOLN 5000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60793031501","type":"CDM"},{"code":"60793031501","type":"NDC"}],"standard_charges":[{"gross_charge":191.91,"discounted_cash":134.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060002","type":"CDM"},{"code":"J0558","type":"HCPCS"},{"code":"60793060002","type":"NDC"}],"standard_charges":[{"gross_charge":1110.28,"discounted_cash":777.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60793060010","type":"CDM"},{"code":"J0558","type":"HCPCS"},{"code":"60793060010","type":"NDC"}],"standard_charges":[{"gross_charge":1945.21,"discounted_cash":1361.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 2400000 UNIT/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070204","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070204","type":"NDC"}],"standard_charges":[{"gross_charge":869.73,"discounted_cash":608.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 2400000 UNIT/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070210","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070210","type":"NDC"}],"standard_charges":[{"gross_charge":1375.21,"discounted_cash":962.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CASIMERSEN IV SOLN 100 MG/2ML (50 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60923022702","type":"CDM"},{"code":"J1426","type":"HCPCS"},{"code":"60923022702","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60951060270","type":"CDM"},{"code":"60951060270","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOTRIMAZOLE VAGINAL CREAM 1%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx61269022041","type":"CDM"},{"code":"61269022041","type":"NDC"}],"standard_charges":[{"gross_charge":30.51,"discounted_cash":21.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx61269073041","type":"CDM"},{"code":"61269073041","type":"NDC"}],"standard_charges":[{"gross_charge":24.57,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL SUPPOS 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61269073607","type":"CDM"},{"code":"61269073607","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":247.26,"discounted_cash":173.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":112.48,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":61.93,"discounted_cash":43.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":344.9,"discounted_cash":241.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020615","type":"CDM"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"gross_charge":379.96,"discounted_cash":265.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022705","type":"CDM"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031801","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":1141.62,"discounted_cash":799.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx61314032601","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":1826.58,"discounted_cash":1278.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx61314032610","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032610","type":"NDC"}],"standard_charges":[{"gross_charge":1826.59,"discounted_cash":1278.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx61314035501","type":"CDM"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":105.15,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61314039601","type":"CDM"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":65.19,"discounted_cash":45.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314062810","type":"CDM"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":69.36,"discounted_cash":48.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063305","type":"CDM"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":47.4,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314063715","type":"CDM"},{"code":"61314063715","type":"NDC"}],"standard_charges":[{"gross_charge":557.64,"discounted_cash":390.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1114.29,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314065625","type":"CDM"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":110.01,"discounted_cash":77.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGFILGRASTIM-BMEZ SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx61314086601","type":"CDM"},{"code":"Q5120","type":"HCPCS"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":16471.01,"discounted_cash":11529.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61703030916","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VINCRISTINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61703030925","type":"CDM"},{"code":"J9370","type":"HCPCS"},{"code":"61703030925","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":590.1,"discounted_cash":413.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBOPLATIN IV SOLN 450 MG/45ML","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"Rx61703033950","type":"CDM"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":200.37,"discounted_cash":140.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx61703034250","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":708.73,"discounted_cash":496.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEMIPLIMAB-RWLC IV SOLN 350 MG/7ML (50 MG/ML)","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"Rx61755000801","type":"CDM"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":69923.47,"discounted_cash":48946.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BICTEGRAVIR-EMTRICITABINE-TENOFOVIR AF TAB 50-200-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958250103","type":"CDM"},{"code":"61958250103","type":"NDC"}],"standard_charges":[{"gross_charge":436.82,"discounted_cash":305.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4001.36,"discounted_cash":2800.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61959000101","type":"CDM"},{"code":"61959000101","type":"NDC"}],"standard_charges":[{"gross_charge":118.04,"discounted_cash":82.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61959000130","type":"CDM"},{"code":"61959000130","type":"NDC"}],"standard_charges":[{"gross_charge":118.04,"discounted_cash":82.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx62135000394","type":"CDM"},{"code":"62135000394","type":"NDC"}],"standard_charges":[{"gross_charge":17.02,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62135019122","type":"CDM"},{"code":"62135019122","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":12.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx62135073024","type":"CDM"},{"code":"62135073024","type":"NDC"}],"standard_charges":[{"gross_charge":202.46,"discounted_cash":141.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL SOLUTION 20 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx62135073045","type":"CDM"},{"code":"62135073045","type":"NDC"}],"standard_charges":[{"gross_charge":202.46,"discounted_cash":141.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327044404","type":"CDM"},{"code":"62327044404","type":"NDC"}],"standard_charges":[{"gross_charge":957.6,"discounted_cash":670.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327044444","type":"CDM"},{"code":"62327044444","type":"NDC"}],"standard_charges":[{"gross_charge":1222.2,"discounted_cash":855.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332004060","type":"CDM"},{"code":"62332004060","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332017260","type":"CDM"},{"code":"62332017260","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM ORALLY DISINTEGRATING TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332036506","type":"CDM"},{"code":"62332036506","type":"NDC"}],"standard_charges":[{"gross_charge":18.43,"discounted_cash":12.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MODAFINIL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332038590","type":"CDM"},{"code":"62332038590","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":11.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332041310","type":"CDM"},{"code":"62332041310","type":"NDC"}],"standard_charges":[{"gross_charge":72.42,"discounted_cash":50.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62332051805","type":"CDM"},{"code":"62332051805","type":"NDC"}],"standard_charges":[{"gross_charge":79.04,"discounted_cash":55.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx62332065501","type":"CDM"},{"code":"62332065501","type":"NDC"}],"standard_charges":[{"gross_charge":111.03,"discounted_cash":77.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx62332065560","type":"CDM"},{"code":"62332065560","type":"NDC"}],"standard_charges":[{"gross_charge":74.49,"discounted_cash":52.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":27.61,"discounted_cash":19.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":73.21,"discounted_cash":51.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559039020","type":"CDM"},{"code":"62559039020","type":"NDC"}],"standard_charges":[{"gross_charge":25.63,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559039050","type":"CDM"},{"code":"62559039050","type":"NDC"}],"standard_charges":[{"gross_charge":25.63,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559042101","type":"CDM"},{"code":"62559042101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx62559043130","type":"CDM"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":568.36,"discounted_cash":397.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THYROID TAB 15 MG (1/4 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559074001","type":"CDM"},{"code":"62559074001","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559074201","type":"CDM"},{"code":"62559074201","type":"NDC"}],"standard_charges":[{"gross_charge":17.24,"discounted_cash":12.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026501","type":"CDM"},{"code":"62584026501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026511","type":"CDM"},{"code":"62584026511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026601","type":"CDM"},{"code":"62584026601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026611","type":"CDM"},{"code":"62584026611","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584081301","type":"CDM"},{"code":"62584081301","type":"NDC"}],"standard_charges":[{"gross_charge":27.06,"discounted_cash":18.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584081311","type":"CDM"},{"code":"62584081311","type":"NDC"}],"standard_charges":[{"gross_charge":23.46,"discounted_cash":16.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098411","type":"CDM"},{"code":"62584098411","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.3,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099411","type":"CDM"},{"code":"62584099411","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756014201","type":"CDM"},{"code":"62756014201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756046188","type":"CDM"},{"code":"62756046188","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756052169","type":"CDM"},{"code":"62756052169","type":"NDC"}],"standard_charges":[{"gross_charge":22.19,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.61,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756079688","type":"CDM"},{"code":"62756079688","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERAMPANEL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856027230","type":"CDM"},{"code":"62856027230","type":"NDC"}],"standard_charges":[{"gross_charge":152.58,"discounted_cash":106.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10466.0,"discounted_cash":7326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3260.45,"discounted_cash":2282.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935022710","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"gross_charge":3260.45,"discounted_cash":2282.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4347.27,"discounted_cash":3043.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5039.39,"discounted_cash":3527.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) FOR SUBCUTANEOUS INJ KIT 45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935046150","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"gross_charge":5039.39,"discounted_cash":3527.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1194.37,"discounted_cash":836.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUPROLIDE ACETATE FOR SUBCUTANEOUS INJ KIT 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62935075680","type":"CDM"},{"code":"J9217","type":"HCPCS"},{"code":"62935075680","type":"NDC"}],"standard_charges":[{"gross_charge":1194.37,"discounted_cash":836.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL (BULK) POWDER","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx62991109501","type":"CDM"},{"code":"62991109501","type":"NDC"}],"standard_charges":[{"gross_charge":135.12,"discounted_cash":94.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":11372.27,"discounted_cash":7960.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63037010005","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63037010005","type":"NDC"}],"standard_charges":[{"gross_charge":119.14,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIMAVANSERIN TARTRATE CAP 34 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63090034030","type":"CDM"},{"code":"63090034030","type":"NDC"}],"standard_charges":[{"gross_charge":428.73,"discounted_cash":300.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304069201","type":"CDM"},{"code":"63304069201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001001","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001003","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001003","type":"NDC"}],"standard_charges":[{"gross_charge":213.01,"discounted_cash":149.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":243.23,"discounted_cash":170.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":385.25,"discounted_cash":269.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001203","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001203","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001207","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001207","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001217","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001217","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001301","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001302","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001309","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001309","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001321","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001321","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006401","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006403","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx63323009004","type":"CDM"},{"code":"63323009004","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"Rx63323009040","type":"CDM"},{"code":"63323009040","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009301","type":"CDM"},{"code":"63323009301","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323009330","type":"CDM"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":51.3,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":177.88,"discounted_cash":124.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":400.97,"discounted_cash":280.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 500 MG/25ML (20 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx63323010425","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":211.02,"discounted_cash":147.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010601","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010605","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML)","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323010615","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010615","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011700","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011700","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011719","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011719","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323011720","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323011731","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011731","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323011751","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323011761","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":182.41,"discounted_cash":127.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323011769","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"63323011769","type":"NDC"}],"standard_charges":[{"gross_charge":182.41,"discounted_cash":127.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYTARABINE INJ PF 100 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323012020","type":"CDM"},{"code":"J9100","type":"HCPCS"},{"code":"63323012020","type":"NDC"}],"standard_charges":[{"gross_charge":129.16,"discounted_cash":90.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012700","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"63323012700","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012710","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"63323012710","type":"NDC"}],"standard_charges":[{"gross_charge":127.32,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012800","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"63323012800","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DACARBAZINE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323012820","type":"CDM"},{"code":"J9130","type":"HCPCS"},{"code":"63323012820","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013002","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013002","type":"NDC"}],"standard_charges":[{"gross_charge":163.87,"discounted_cash":114.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":132.55,"discounted_cash":92.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1264.1,"discounted_cash":884.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016100","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016100","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016200","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016200","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323017301","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323017301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323018000","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018000","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":97.34,"discounted_cash":68.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323018507","type":"CDM"},{"code":"63323018507","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018601","type":"CDM"},{"code":"63323018601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018610","type":"CDM"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018620","type":"CDM"},{"code":"63323018620","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2896.63,"discounted_cash":2027.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020101","type":"CDM"},{"code":"63323020101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020103","type":"CDM"},{"code":"63323020103","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022901","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022915","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022915","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022921","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022921","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":125.28,"discounted_cash":87.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323026001","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323026001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323026037","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323026037","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026203","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026203","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026206","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026206","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323026530","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"63323026530","type":"NDC"}],"standard_charges":[{"gross_charge":333.67,"discounted_cash":233.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026922","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026922","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323026950","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323026965","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":80.68,"discounted_cash":56.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323027601","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323027601","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323027602","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323027602","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":622.79,"discounted_cash":435.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028507","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028507","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028611","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028611","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028623","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028635","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028693","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028693","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028695","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028695","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029401","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323030301","type":"CDM"},{"code":"63323030301","type":"NDC"}],"standard_charges":[{"gross_charge":692.21,"discounted_cash":484.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":547.6,"discounted_cash":383.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 40.5 GM (36-4.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323030478","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"63323030478","type":"NDC"}],"standard_charges":[{"gross_charge":594.32,"discounted_cash":416.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323032503","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032503","type":"NDC"}],"standard_charges":[{"gross_charge":152.86,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323032509","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032509","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":33.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323032510","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323032520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323034610","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"63323034610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN FOR INJ 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323035120","type":"CDM"},{"code":"J2804","type":"HCPCS"},{"code":"63323035120","type":"NDC"}],"standard_charges":[{"gross_charge":1224.2,"discounted_cash":856.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036001","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036003","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036003","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036059","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037600","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037600","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040101","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040101","type":"NDC"}],"standard_charges":[{"gross_charge":265.71,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":215.23,"discounted_cash":150.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040201","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040201","type":"NDC"}],"standard_charges":[{"gross_charge":531.18,"discounted_cash":371.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":439.54,"discounted_cash":307.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323041701","type":"CDM"},{"code":"63323041701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323041710","type":"CDM"},{"code":"63323041710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323042405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043400","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043441","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043441","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323045200","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"63323045200","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046101","type":"CDM"},{"code":"63323046101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046202","type":"CDM"},{"code":"63323046202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323046301","type":"CDM"},{"code":"63323046301","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323046357","type":"CDM"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"gross_charge":167.06,"discounted_cash":116.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046401","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046417","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046801","type":"CDM"},{"code":"63323046801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046802","type":"CDM"},{"code":"63323046802","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047400","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047400","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLOROPROCAINE HCL PRESERVATIVE FREE (PF) INJ 3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323047801","type":"CDM"},{"code":"J2401","type":"HCPCS"},{"code":"63323047801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 0.5% W/ EPINEPHRINE-1:200000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048101","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048205","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048241","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048241","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048303","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048303","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048602","type":"CDM"},{"code":"63323048602","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048627","type":"CDM"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048902","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048902","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049101","type":"CDM"},{"code":"63323049101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049157","type":"CDM"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049204","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049204","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049207","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049207","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049209","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049209","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049237","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049243","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049243","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049257","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323049401","type":"NDC"}],"standard_charges":[{"gross_charge":54.46,"discounted_cash":38.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"gross_charge":58.75,"discounted_cash":41.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050600","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050600","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050601","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323050616","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050701","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050801","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050801","type":"NDC"}],"standard_charges":[{"gross_charge":46.88,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":46.54,"discounted_cash":32.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051701","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051701","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051774","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323051901","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051901","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SOD (PORCINE)-NACL IV SOLN 1000 UNIT/500ML-0.9%,HEPARIN SOD (PORCINE)-NACL IV SOLN 2000 UNIT/L-0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323051910","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051910","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323054005","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054005","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054005","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054005","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323054011","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055921","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055921","type":"NDC"}],"standard_charges":[{"gross_charge":48.53,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055993","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055993","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056421","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056421","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":45.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056497","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056621","type":"NDC"}],"standard_charges":[{"gross_charge":81.08,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056698","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056698","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323057901","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"63323057901","type":"NDC"}],"standard_charges":[{"gross_charge":865.41,"discounted_cash":605.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323057905","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"63323057905","type":"NDC"}],"standard_charges":[{"gross_charge":674.39,"discounted_cash":472.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058621","type":"NDC"}],"standard_charges":[{"gross_charge":145.01,"discounted_cash":101.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":61.13,"discounted_cash":42.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323058921","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058921","type":"NDC"}],"standard_charges":[{"gross_charge":254.04,"discounted_cash":177.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323058994","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058994","type":"NDC"}],"standard_charges":[{"gross_charge":90.98,"discounted_cash":63.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059303","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059303","type":"NDC"}],"standard_charges":[{"gross_charge":987.45,"discounted_cash":691.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059603","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059603","type":"NDC"}],"standard_charges":[{"gross_charge":924.24,"discounted_cash":646.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":924.25,"discounted_cash":646.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059613","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059613","type":"NDC"}],"standard_charges":[{"gross_charge":987.11,"discounted_cash":690.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":118.57,"discounted_cash":83.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323060400","type":"CDM"},{"code":"J1800","type":"HCPCS"},{"code":"63323060400","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323061400","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061400","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061401","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061421","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061421","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061455","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061455","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061601","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061601","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061603","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":819.91,"discounted_cash":573.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323065210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":144.35,"discounted_cash":101.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":414.53,"discounted_cash":290.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066401","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066500","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066500","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066501","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323068601","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323068601","type":"NDC"}],"standard_charges":[{"gross_charge":283.92,"discounted_cash":198.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx63323068610","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323068610","type":"NDC"}],"standard_charges":[{"gross_charge":283.92,"discounted_cash":198.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072301","type":"CDM"},{"code":"63323072301","type":"NDC"}],"standard_charges":[{"gross_charge":475.02,"discounted_cash":332.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":693.36,"discounted_cash":485.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":463.42,"discounted_cash":324.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072910","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072910","type":"NDC"}],"standard_charges":[{"gross_charge":298.33,"discounted_cash":208.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073911","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073911","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323075110","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075110","type":"NDC"}],"standard_charges":[{"gross_charge":421.55,"discounted_cash":295.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1376.97,"discounted_cash":963.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323078110","type":"CDM"},{"code":"63323078110","type":"NDC"}],"standard_charges":[{"gross_charge":45.77,"discounted_cash":32.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323078121","type":"CDM"},{"code":"63323078121","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080601","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080601","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080611","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080611","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080614","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080614","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323080650","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"63323080650","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323082426","type":"CDM"},{"code":"63323082426","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx63323082476","type":"CDM"},{"code":"63323082476","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323085103","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085103","type":"NDC"}],"standard_charges":[{"gross_charge":30.84,"discounted_cash":21.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323085110","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085110","type":"NDC"}],"standard_charges":[{"gross_charge":36.58,"discounted_cash":25.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323087010","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"63323087010","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx63323088101","type":"CDM"},{"code":"63323088101","type":"NDC"}],"standard_charges":[{"gross_charge":355.42,"discounted_cash":248.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.0,"type":"ML"},"code_information":[{"code":"Rx63323088116","type":"CDM"},{"code":"63323088116","type":"NDC"}],"standard_charges":[{"gross_charge":227.9,"discounted_cash":159.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323092401","type":"CDM"},{"code":"63323092401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323092410","type":"CDM"},{"code":"63323092410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093000","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093000","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093001","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323096501","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096502","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5012.72,"discounted_cash":3508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15616.87,"discounted_cash":10931.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMACETAXINE MEPESUCCINATE FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63459017714","type":"CDM"},{"code":"J9262","type":"HCPCS"},{"code":"63459017714","type":"NDC"}],"standard_charges":[{"gross_charge":6666.62,"discounted_cash":4666.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":14227.05,"discounted_cash":9958.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1099.98,"discounted_cash":769.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1759.96,"discounted_cash":1231.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091212","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091212","type":"NDC"}],"standard_charges":[{"gross_charge":1779.69,"discounted_cash":1245.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":29.56,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZOCAINE OINT 20%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx63736004130","type":"CDM"},{"code":"63736004130","type":"NDC"}],"standard_charges":[{"gross_charge":34.44,"discounted_cash":24.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERMETHRIN CREME RINSE 1%","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx63736012002","type":"CDM"},{"code":"63736012002","type":"NDC"}],"standard_charges":[{"gross_charge":67.96,"discounted_cash":47.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PERMETHRIN CREME RINSE 1%","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx63736012003","type":"CDM"},{"code":"63736012003","type":"NDC"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":37.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx63736014308","type":"CDM"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"gross_charge":47.64,"discounted_cash":33.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739000333","type":"CDM"},{"code":"63739000333","type":"NDC"}],"standard_charges":[{"gross_charge":30.18,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739001510","type":"CDM"},{"code":"63739001510","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005110","type":"CDM"},{"code":"63739005110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.05,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007910","type":"CDM"},{"code":"63739007910","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012810","type":"CDM"},{"code":"63739012810","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739014510","type":"CDM"},{"code":"63739014510","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63739019601","type":"CDM"},{"code":"63739019601","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63739019610","type":"CDM"},{"code":"63739019610","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739021202","type":"CDM"},{"code":"63739021202","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739022510","type":"CDM"},{"code":"63739022510","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739023610","type":"CDM"},{"code":"63739023610","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026310","type":"CDM"},{"code":"63739026310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739028310","type":"CDM"},{"code":"63739028310","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739029310","type":"CDM"},{"code":"63739029310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739032710","type":"CDM"},{"code":"63739032710","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739034910","type":"CDM"},{"code":"63739034910","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739035010","type":"CDM"},{"code":"63739035010","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739035510","type":"CDM"},{"code":"63739035510","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NAPROXEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739040310","type":"CDM"},{"code":"63739040310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043210","type":"CDM"},{"code":"63739043210","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043402","type":"CDM"},{"code":"63739043402","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739047802","type":"CDM"},{"code":"63739047802","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739048310","type":"CDM"},{"code":"63739048310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739052301","type":"CDM"},{"code":"63739052301","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739054410","type":"CDM"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739055910","type":"CDM"},{"code":"63739055910","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739056710","type":"CDM"},{"code":"63739056710","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739059110","type":"CDM"},{"code":"63739059110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739066510","type":"CDM"},{"code":"63739066510","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067210","type":"CDM"},{"code":"63739067210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067310","type":"CDM"},{"code":"63739067310","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067810","type":"CDM"},{"code":"63739067810","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739068410","type":"CDM"},{"code":"63739068410","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739068610","type":"CDM"},{"code":"63739068610","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739069110","type":"CDM"},{"code":"63739069110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070110","type":"CDM"},{"code":"63739070110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALLOPURINOL TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739079610","type":"CDM"},{"code":"63739079610","type":"NDC"}],"standard_charges":[{"gross_charge":16.45,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090210","type":"CDM"},{"code":"63739090210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090310","type":"CDM"},{"code":"63739090310","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739094310","type":"CDM"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739099210","type":"CDM"},{"code":"63739099210","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63824000815","type":"CDM"},{"code":"63824000815","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3143.02,"discounted_cash":2200.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4460.15,"discounted_cash":3122.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000-2400 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833061702","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833061702","type":"NDC"}],"standard_charges":[{"gross_charge":8243.32,"discounted_cash":5770.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 250-600 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833062501","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833062501","type":"NDC"}],"standard_charges":[{"gross_charge":3143.02,"discounted_cash":2200.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500-1200 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833062601","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833062601","type":"NDC"}],"standard_charges":[{"gross_charge":5015.52,"discounted_cash":3510.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000-2400 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63833062701","type":"CDM"},{"code":"J7187","type":"HCPCS"},{"code":"63833062701","type":"NDC"}],"standard_charges":[{"gross_charge":10030.97,"discounted_cash":7021.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16032.36,"discounted_cash":11222.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64193042602","type":"CDM"},{"code":"J7198","type":"HCPCS"},{"code":"64193042602","type":"NDC"}],"standard_charges":[{"gross_charge":3835.1,"discounted_cash":2684.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64253033335","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx64253040030","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"64253040030","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx64253040091","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090030","type":"CDM"},{"code":"64253090030","type":"NDC"}],"standard_charges":[{"gross_charge":65.07,"discounted_cash":45.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090091","type":"CDM"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":62.26,"discounted_cash":43.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE CHLORIDE INHAL FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64281010000","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"64281010000","type":"NDC"}],"standard_charges":[{"gross_charge":334.73,"discounted_cash":234.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHACHOLINE CHLORIDE INHAL FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64281010006","type":"CDM"},{"code":"J7674","type":"HCPCS"},{"code":"64281010006","type":"NDC"}],"standard_charges":[{"gross_charge":386.18,"discounted_cash":270.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380015801","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"64380015801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380017201","type":"CDM"},{"code":"64380017201","type":"NDC"}],"standard_charges":[{"gross_charge":19.37,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380017202","type":"CDM"},{"code":"64380017202","type":"NDC"}],"standard_charges":[{"gross_charge":18.36,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380072306","type":"CDM"},{"code":"64380072306","type":"NDC"}],"standard_charges":[{"gross_charge":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380074106","type":"CDM"},{"code":"64380074106","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380078206","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380078206","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380079701","type":"CDM"},{"code":"64380079701","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380088304","type":"CDM"},{"code":"64380088304","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380091806","type":"CDM"},{"code":"64380091806","type":"NDC"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380094906","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380094906","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":31796.57,"discounted_cash":22257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx64679046550","type":"CDM"},{"code":"64679046550","type":"NDC"}],"standard_charges":[{"gross_charge":262.39,"discounted_cash":183.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx64679046551","type":"CDM"},{"code":"64679046551","type":"NDC"}],"standard_charges":[{"gross_charge":172.84,"discounted_cash":120.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx64679072801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx64679072808","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072808","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64720013210","type":"CDM"},{"code":"64720013210","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764011907","type":"CDM"},{"code":"64764011907","type":"NDC"}],"standard_charges":[{"gross_charge":71.17,"discounted_cash":49.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":40884.55,"discounted_cash":28619.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA CAP ER 36.25-145 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64896066201","type":"CDM"},{"code":"64896066201","type":"NDC"}],"standard_charges":[{"gross_charge":32.97,"discounted_cash":23.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64950034316","type":"CDM"},{"code":"64950034316","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx64950037416","type":"CDM"},{"code":"64950037416","type":"NDC"}],"standard_charges":[{"gross_charge":69.01,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980016901","type":"CDM"},{"code":"64980016901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx64980032430","type":"CDM"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":94.92,"discounted_cash":66.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":157.07,"discounted_cash":109.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITAZOXANIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980052660","type":"CDM"},{"code":"64980052660","type":"NDC"}],"standard_charges":[{"gross_charge":404.22,"discounted_cash":282.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980057301","type":"CDM"},{"code":"64980057301","type":"NDC"}],"standard_charges":[{"gross_charge":15.22,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65145010910","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"65145010910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162027210","type":"CDM"},{"code":"65162027210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB ER 500 MG (ANTIHYPERLIPIDEMIC)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162032109","type":"CDM"},{"code":"65162032109","type":"NDC"}],"standard_charges":[{"gross_charge":15.49,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162064110","type":"CDM"},{"code":"65162064110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE SOLN 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65162067384","type":"CDM"},{"code":"65162067384","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068110","type":"CDM"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068210","type":"CDM"},{"code":"65162068210","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162074510","type":"CDM"},{"code":"65162074510","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.35,"discounted_cash":12.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162079104","type":"CDM"},{"code":"65162079104","type":"NDC"}],"standard_charges":[{"gross_charge":23.35,"discounted_cash":16.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162079108","type":"CDM"},{"code":"65162079108","type":"NDC"}],"standard_charges":[{"gross_charge":23.24,"discounted_cash":16.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089609","type":"CDM"},{"code":"65162089609","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089709","type":"CDM"},{"code":"65162089709","type":"NDC"}],"standard_charges":[{"gross_charge":15.51,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE OINT 5%","drug_information":{"unit":35.44,"type":"GM"},"code_information":[{"code":"Rx65162091838","type":"CDM"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"gross_charge":117.72,"discounted_cash":82.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM IODIDE I-131 PO CAPS (DIAGNOSTIC-PER 100 MICROCURIE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65174088025","type":"CDM"},{"code":"A9528","type":"HCPCS"},{"code":"65174088025","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65219012012","type":"CDM"},{"code":"J0875","type":"HCPCS"},{"code":"65219012012","type":"NDC"}],"standard_charges":[{"gross_charge":4533.09,"discounted_cash":3173.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx65219016201","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"65219016201","type":"NDC"}],"standard_charges":[{"gross_charge":139.98,"discounted_cash":97.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx65219016210","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"65219016210","type":"NDC"}],"standard_charges":[{"gross_charge":62.12,"discounted_cash":43.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx65219025700","type":"CDM"},{"code":"65219025700","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx65219025701","type":"CDM"},{"code":"65219025701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029300","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029301","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219036801","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"65219036801","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219036802","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGFILGRASTIM-FPGK SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx65219037110","type":"CDM"},{"code":"Q5127","type":"HCPCS"},{"code":"65219037110","type":"NDC"}],"standard_charges":[{"gross_charge":24193.64,"discounted_cash":16935.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65219056800","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"65219056800","type":"NDC"}],"standard_charges":[{"gross_charge":1176.87,"discounted_cash":823.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAM-TRASTUZUMAB DERUXTECAN-NXKI FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597040601","type":"CDM"},{"code":"J9358","type":"HCPCS"},{"code":"65597040601","type":"NDC"}],"standard_charges":[{"gross_charge":19040.44,"discounted_cash":13328.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DATOPOTAMAB DERUXTECAN-DLNK FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65597080101","type":"CDM"},{"code":"J9011","type":"HCPCS"},{"code":"65597080101","type":"NDC"}],"standard_charges":[{"gross_charge":30172.98,"discounted_cash":21121.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628005001","type":"CDM"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"gross_charge":26.08,"discounted_cash":18.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65628008003","type":"CDM"},{"code":"65628008003","type":"NDC"}],"standard_charges":[{"gross_charge":86.72,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":23.6,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030302","type":"CDM"},{"code":"65649030302","type":"NDC"}],"standard_charges":[{"gross_charge":244.95,"discounted_cash":171.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":244.95,"discounted_cash":171.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":906.75,"discounted_cash":634.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":6801.73,"discounted_cash":4761.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001701","type":"CDM"},{"code":"65862001701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRTAZAPINE ORALLY DISINTEGRATING TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862002206","type":"CDM"},{"code":"65862002206","type":"NDC"}],"standard_charges":[{"gross_charge":16.13,"discounted_cash":11.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862007150","type":"CDM"},{"code":"65862007150","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862007601","type":"CDM"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENAZEPRIL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862011601","type":"CDM"},{"code":"65862011601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014736","type":"CDM"},{"code":"65862014736","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":11.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014990","type":"CDM"},{"code":"65862014990","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019201","type":"CDM"},{"code":"65862019201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019301","type":"CDM"},{"code":"65862019301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020190","type":"CDM"},{"code":"65862020190","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.47,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx65862021860","type":"CDM"},{"code":"65862021860","type":"NDC"}],"standard_charges":[{"gross_charge":32.54,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862023060","type":"CDM"},{"code":"65862023060","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862024608","type":"CDM"},{"code":"65862024608","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862025047","type":"CDM"},{"code":"65862025047","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862039010","type":"CDM"},{"code":"65862039010","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":11.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862039110","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"65862039110","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862042001","type":"CDM"},{"code":"65862042001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050301","type":"CDM"},{"code":"65862050301","type":"NDC"}],"standard_charges":[{"gross_charge":16.33,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050320","type":"CDM"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"gross_charge":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052790","type":"CDM"},{"code":"65862052790","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052830","type":"CDM"},{"code":"65862052830","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052890","type":"CDM"},{"code":"65862052890","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx65862053450","type":"CDM"},{"code":"65862053450","type":"NDC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862053513","type":"CDM"},{"code":"65862053513","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862059501","type":"CDM"},{"code":"65862059501","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067601","type":"CDM"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALPRAZOLAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067801","type":"CDM"},{"code":"65862067801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069920","type":"CDM"},{"code":"65862069920","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862083130","type":"CDM"},{"code":"65862083130","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862092127","type":"CDM"},{"code":"65862092127","type":"NDC"}],"standard_charges":[{"gross_charge":15.47,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPOPROSTENOL SODIUM FOR INJ 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66215040301","type":"CDM"},{"code":"J1325","type":"HCPCS"},{"code":"66215040301","type":"NDC"}],"standard_charges":[{"gross_charge":240.03,"discounted_cash":168.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000201","type":"CDM"},{"code":"66553000201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100100","type":"CDM"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"gross_charge":19.27,"discounted_cash":13.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 500-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100200","type":"CDM"},{"code":"66685100200","type":"NDC"}],"standard_charges":[{"gross_charge":20.58,"discounted_cash":14.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66685101200","type":"CDM"},{"code":"66685101200","type":"NDC"}],"standard_charges":[{"gross_charge":21.74,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx66689003201","type":"CDM"},{"code":"66689003201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66689004701","type":"CDM"},{"code":"66689004701","type":"NDC"}],"standard_charges":[{"gross_charge":32.13,"discounted_cash":22.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689011408","type":"CDM"},{"code":"66689011408","type":"NDC"}],"standard_charges":[{"gross_charge":87.12,"discounted_cash":60.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689020208","type":"CDM"},{"code":"66689020208","type":"NDC"}],"standard_charges":[{"gross_charge":72.72,"discounted_cash":50.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5721.82,"discounted_cash":4005.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx66758005003","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"66758005003","type":"NDC"}],"standard_charges":[{"gross_charge":819.52,"discounted_cash":573.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":155.38,"discounted_cash":108.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOFLURANE INHAL SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx66794001725","type":"CDM"},{"code":"66794001725","type":"NDC"}],"standard_charges":[{"gross_charge":244.75,"discounted_cash":171.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOFLURANE INHAL SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx66794001910","type":"CDM"},{"code":"66794001910","type":"NDC"}],"standard_charges":[{"gross_charge":158.76,"discounted_cash":111.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021943","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":61.27,"discounted_cash":42.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021963","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021963","type":"NDC"}],"standard_charges":[{"gross_charge":306.5,"discounted_cash":214.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023002","type":"CDM"},{"code":"66794023002","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023042","type":"CDM"},{"code":"66794023042","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL INJ 200 MCG/2ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 400 MCG/4ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 1000 MCG/10ML (FOR IV INFUSION)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023302","type":"CDM"},{"code":"66794023302","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL INJ 200 MCG/2ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 400 MCG/4ML (FOR IV INFUSION),DEXMEDETOMIDINE HCL INJ 1000 MCG/10ML (FOR IV INFUSION)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx66794023342","type":"CDM"},{"code":"66794023342","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATOVAQUONE-PROGUANIL HCL TAB 250-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993006027","type":"CDM"},{"code":"66993006027","type":"NDC"}],"standard_charges":[{"gross_charge":24.91,"discounted_cash":17.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993016502","type":"CDM"},{"code":"66993016502","type":"NDC"}],"standard_charges":[{"gross_charge":38.75,"discounted_cash":27.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx66993037025","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"66993037025","type":"NDC"}],"standard_charges":[{"gross_charge":390.44,"discounted_cash":273.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx66993037083","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"gross_charge":390.91,"discounted_cash":273.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993073051","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"66993073051","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993073080","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"66993073080","type":"NDC"}],"standard_charges":[{"gross_charge":18.83,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SECRETIN ACETATE (HUMAN) FOR INJ 16 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67066000501","type":"CDM"},{"code":"J2850","type":"HCPCS"},{"code":"67066000501","type":"NDC"}],"standard_charges":[{"gross_charge":3244.5,"discounted_cash":2271.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2165.47,"discounted_cash":1515.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2141.03,"discounted_cash":1498.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPTINEZUMAB-JJMR IV SOLN 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67386013051","type":"CDM"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":8474.32,"discounted_cash":5932.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM TETRADECYL SULFATE INJ 1%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457016200","type":"CDM"},{"code":"67457016200","type":"NDC"}],"standard_charges":[{"gross_charge":150.76,"discounted_cash":105.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":149.09,"discounted_cash":104.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018200","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018200","type":"NDC"}],"standard_charges":[{"gross_charge":56.91,"discounted_cash":39.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":53.4,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457019600","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"67457019600","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457019700","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"67457019700","type":"NDC"}],"standard_charges":[{"gross_charge":121.9,"discounted_cash":85.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457019710","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"67457019710","type":"NDC"}],"standard_charges":[{"gross_charge":62.7,"discounted_cash":43.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019800","type":"CDM"},{"code":"67457019800","type":"NDC"}],"standard_charges":[{"gross_charge":467.22,"discounted_cash":327.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019803","type":"CDM"},{"code":"67457019803","type":"NDC"}],"standard_charges":[{"gross_charge":467.22,"discounted_cash":327.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457021720","type":"CDM"},{"code":"J1230","type":"HCPCS"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":222.27,"discounted_cash":155.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLONIDINE HCL INJ (FOR EPIDURAL INFUSION) 100 MCG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457021810","type":"CDM"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":95.59,"discounted_cash":66.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457022000","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022000","type":"NDC"}],"standard_charges":[{"gross_charge":2522.11,"discounted_cash":1765.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2521.28,"discounted_cash":1764.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029100","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"67457029100","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029200","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029200","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029202","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457029900","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029900","type":"NDC"}],"standard_charges":[{"gross_charge":80.26,"discounted_cash":56.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457029910","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029910","type":"NDC"}],"standard_charges":[{"gross_charge":79.39,"discounted_cash":55.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033900","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033900","type":"NDC"}],"standard_charges":[{"gross_charge":65.35,"discounted_cash":45.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033950","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"gross_charge":63.82,"discounted_cash":44.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034000","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034000","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457035101","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67457035101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457035110","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67457035110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457035959","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"67457035959","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457040900","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"67457040900","type":"NDC"}],"standard_charges":[{"gross_charge":51.65,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457040913","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"67457040913","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041900","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041900","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041901","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042000","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042000","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042010","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042300","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042600","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042600","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042612","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457043010","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":74.01,"discounted_cash":51.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043300","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043322","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043700","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"67457043700","type":"NDC"}],"standard_charges":[{"gross_charge":135.52,"discounted_cash":94.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043710","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"67457043710","type":"NDC"}],"standard_charges":[{"gross_charge":134.01,"discounted_cash":93.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043800","type":"CDM"},{"code":"67457043800","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043810","type":"CDM"},{"code":"67457043810","type":"NDC"}],"standard_charges":[{"gross_charge":45.81,"discounted_cash":32.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047300","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047322","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457048300","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457048300","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 100 MG/10ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457048310","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457048310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457051805","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"67457051805","type":"NDC"}],"standard_charges":[{"gross_charge":575.03,"discounted_cash":402.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052040","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"67457052040","type":"NDC"}],"standard_charges":[{"gross_charge":8651.21,"discounted_cash":6055.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457053035","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":196.68,"discounted_cash":137.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx67457053316","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"67457053316","type":"NDC"}],"standard_charges":[{"gross_charge":911.88,"discounted_cash":638.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx67457061610","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"67457061610","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx67457061730","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":128.72,"discounted_cash":90.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457062310","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"67457062310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457062399","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"67457062399","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457062910","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"67457062910","type":"NDC"}],"standard_charges":[{"gross_charge":160.66,"discounted_cash":112.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457063110","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"67457063110","type":"NDC"}],"standard_charges":[{"gross_charge":613.92,"discounted_cash":429.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063800","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063800","type":"NDC"}],"standard_charges":[{"gross_charge":128.65,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063810","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063810","type":"NDC"}],"standard_charges":[{"gross_charge":69.41,"discounted_cash":48.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063900","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063900","type":"NDC"}],"standard_charges":[{"gross_charge":128.65,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx67457063910","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"67457063910","type":"NDC"}],"standard_charges":[{"gross_charge":69.41,"discounted_cash":48.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":867.91,"discounted_cash":607.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGFILGRASTIM-JMDB SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx67457083306","type":"CDM"},{"code":"Q5108","type":"HCPCS"},{"code":"67457083306","type":"NDC"}],"standard_charges":[{"gross_charge":9946.26,"discounted_cash":6962.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx67457085200","type":"CDM"},{"code":"67457085200","type":"NDC"}],"standard_charges":[{"gross_charge":60.02,"discounted_cash":42.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx67457085204","type":"CDM"},{"code":"67457085204","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":389.95,"discounted_cash":272.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085500","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085500","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085502","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ADENOSINE IV SOLN 3 MG/ML (DIAGNOSTIC)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx67457085730","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085730","type":"NDC"}],"standard_charges":[{"gross_charge":128.12,"discounted_cash":89.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GRANISETRON HCL INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457086301","type":"CDM"},{"code":"J1626","type":"HCPCS"},{"code":"67457086301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx67618020004","type":"CDM"},{"code":"67618020004","type":"NDC"}],"standard_charges":[{"gross_charge":34.69,"discounted_cash":24.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":103.02,"discounted_cash":72.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877015901","type":"CDM"},{"code":"67877015901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877021901","type":"CDM"},{"code":"67877021901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022001","type":"CDM"},{"code":"67877022001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022301","type":"CDM"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877024201","type":"CDM"},{"code":"67877024201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877025001","type":"CDM"},{"code":"67877025001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877029505","type":"CDM"},{"code":"67877029505","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877031901","type":"CDM"},{"code":"67877031901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877032001","type":"CDM"},{"code":"67877032001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041401","type":"CDM"},{"code":"67877041401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041933","type":"CDM"},{"code":"67877041933","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041984","type":"CDM"},{"code":"67877041984","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":21.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049030","type":"CDM"},{"code":"67877049030","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049090","type":"CDM"},{"code":"67877049090","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877049160","type":"CDM"},{"code":"67877049160","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877050330","type":"CDM"},{"code":"67877050330","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054568","type":"CDM"},{"code":"67877054568","type":"NDC"}],"standard_charges":[{"gross_charge":17.07,"discounted_cash":11.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx67877054798","type":"CDM"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":23.21,"discounted_cash":16.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOLVAPTAN TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877063602","type":"CDM"},{"code":"67877063602","type":"NDC"}],"standard_charges":[{"gross_charge":388.61,"discounted_cash":272.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LURASIDONE HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877063930","type":"CDM"},{"code":"67877063930","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877075360","type":"CDM"},{"code":"67877075360","type":"NDC"}],"standard_charges":[{"gross_charge":22.22,"discounted_cash":15.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877084201","type":"CDM"},{"code":"67877084201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1355.66,"discounted_cash":948.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMEPRAZOLE-SODIUM BICARBONATE POWD PACK FOR SUSP 20-1680 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68012005230","type":"CDM"},{"code":"68012005230","type":"NDC"}],"standard_charges":[{"gross_charge":342.5,"discounted_cash":239.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004411","type":"CDM"},{"code":"68084004411","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004501","type":"CDM"},{"code":"68084004501","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004511","type":"CDM"},{"code":"68084004511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005201","type":"CDM"},{"code":"68084005201","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006911","type":"CDM"},{"code":"68084006911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007011","type":"CDM"},{"code":"68084007011","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.32,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009801","type":"CDM"},{"code":"68084009801","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009811","type":"CDM"},{"code":"68084009811","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084014911","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"68084014911","type":"NDC"}],"standard_charges":[{"gross_charge":19.58,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015401","type":"CDM"},{"code":"68084015401","type":"NDC"}],"standard_charges":[{"gross_charge":15.92,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015411","type":"CDM"},{"code":"68084015411","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018901","type":"CDM"},{"code":"68084018901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018911","type":"CDM"},{"code":"68084018911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.81,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020211","type":"CDM"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.85,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020411","type":"CDM"},{"code":"68084020411","type":"NDC"}],"standard_charges":[{"gross_charge":16.15,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINOXIDIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020501","type":"CDM"},{"code":"68084020501","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINOXIDIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020511","type":"CDM"},{"code":"68084020511","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021401","type":"CDM"},{"code":"68084021401","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021411","type":"CDM"},{"code":"68084021411","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084022901","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":17.29,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084022911","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68084022911","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023001","type":"CDM"},{"code":"68084023001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023011","type":"CDM"},{"code":"68084023011","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024301","type":"CDM"},{"code":"68084024301","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024311","type":"CDM"},{"code":"68084024311","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025301","type":"CDM"},{"code":"68084025301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025311","type":"CDM"},{"code":"68084025311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025401","type":"CDM"},{"code":"68084025401","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084025411","type":"CDM"},{"code":"68084025411","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028801","type":"CDM"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028811","type":"CDM"},{"code":"68084028811","type":"NDC"}],"standard_charges":[{"gross_charge":17.18,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029901","type":"CDM"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029911","type":"CDM"},{"code":"68084029911","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030911","type":"CDM"},{"code":"68084030911","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084030921","type":"CDM"},{"code":"68084030921","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":20.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031301","type":"CDM"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":13.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031311","type":"CDM"},{"code":"68084031311","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031901","type":"CDM"},{"code":"68084031901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031911","type":"CDM"},{"code":"68084031911","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032601","type":"CDM"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"gross_charge":16.95,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032611","type":"CDM"},{"code":"68084032611","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032811","type":"CDM"},{"code":"68084032811","type":"NDC"}],"standard_charges":[{"gross_charge":23.41,"discounted_cash":16.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032821","type":"CDM"},{"code":"68084032821","type":"NDC"}],"standard_charges":[{"gross_charge":27.49,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.32,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.06,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.09,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOPIRAMATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034411","type":"CDM"},{"code":"68084034411","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034601","type":"CDM"},{"code":"68084034601","type":"NDC"}],"standard_charges":[{"gross_charge":15.87,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034611","type":"CDM"},{"code":"68084034611","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034701","type":"CDM"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034711","type":"CDM"},{"code":"68084034711","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035401","type":"CDM"},{"code":"68084035401","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035411","type":"CDM"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039611","type":"CDM"},{"code":"68084039611","type":"NDC"}],"standard_charges":[{"gross_charge":21.58,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039665","type":"CDM"},{"code":"68084039665","type":"NDC"}],"standard_charges":[{"gross_charge":21.56,"discounted_cash":15.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040011","type":"CDM"},{"code":"68084040011","type":"NDC"}],"standard_charges":[{"gross_charge":15.96,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOMETHACIN CAP ER 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041121","type":"CDM"},{"code":"68084041121","type":"NDC"}],"standard_charges":[{"gross_charge":24.4,"discounted_cash":17.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":22.25,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB ER 24 HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084041511","type":"CDM"},{"code":"68084041511","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":14.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084042311","type":"CDM"},{"code":"68084042311","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044711","type":"CDM"},{"code":"68084044711","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044901","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084044901","type":"NDC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":12.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044911","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084044911","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045001","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045001","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045011","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045011","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045101","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045101","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":53.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047211","type":"CDM"},{"code":"68084047211","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047911","type":"CDM"},{"code":"68084047911","type":"NDC"}],"standard_charges":[{"gross_charge":19.4,"discounted_cash":13.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048011","type":"CDM"},{"code":"68084048011","type":"NDC"}],"standard_charges":[{"gross_charge":20.53,"discounted_cash":14.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.96,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.2,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMVASTATIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084051101","type":"CDM"},{"code":"68084051101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084051201","type":"CDM"},{"code":"68084051201","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMVASTATIN TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084051211","type":"CDM"},{"code":"68084051211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053601","type":"CDM"},{"code":"68084053601","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053611","type":"CDM"},{"code":"68084053611","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMAZEPAM CAP 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084054911","type":"CDM"},{"code":"68084054911","type":"NDC"}],"standard_charges":[{"gross_charge":38.37,"discounted_cash":26.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057201","type":"CDM"},{"code":"68084057201","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057211","type":"CDM"},{"code":"68084057211","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.87,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059711","type":"CDM"},{"code":"68084059711","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061701","type":"CDM"},{"code":"68084061701","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084061711","type":"CDM"},{"code":"68084061711","type":"NDC"}],"standard_charges":[{"gross_charge":15.13,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064001","type":"CDM"},{"code":"68084064001","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064011","type":"CDM"},{"code":"68084064011","type":"NDC"}],"standard_charges":[{"gross_charge":15.42,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.04,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064565","type":"CDM"},{"code":"68084064565","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065125","type":"CDM"},{"code":"68084065125","type":"NDC"}],"standard_charges":[{"gross_charge":30.67,"discounted_cash":21.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065195","type":"CDM"},{"code":"68084065195","type":"NDC"}],"standard_charges":[{"gross_charge":36.52,"discounted_cash":25.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.72,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.16,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067511","type":"CDM"},{"code":"68084067511","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067521","type":"CDM"},{"code":"68084067521","type":"NDC"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067601","type":"CDM"},{"code":"68084067601","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067611","type":"CDM"},{"code":"68084067611","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.39,"discounted_cash":14.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21.47,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069701","type":"CDM"},{"code":"68084069701","type":"NDC"}],"standard_charges":[{"gross_charge":17.74,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069711","type":"CDM"},{"code":"68084069711","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069801","type":"CDM"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069811","type":"CDM"},{"code":"68084069811","type":"NDC"}],"standard_charges":[{"gross_charge":15.96,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070825","type":"CDM"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070895","type":"CDM"},{"code":"68084070895","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070901","type":"CDM"},{"code":"68084070901","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070911","type":"CDM"},{"code":"68084070911","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084076211","type":"CDM"},{"code":"68084076211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077211","type":"CDM"},{"code":"68084077211","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077525","type":"CDM"},{"code":"68084077525","type":"NDC"}],"standard_charges":[{"gross_charge":17.62,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077595","type":"CDM"},{"code":"68084077595","type":"NDC"}],"standard_charges":[{"gross_charge":16.66,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078825","type":"CDM"},{"code":"68084078825","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLIMEPIRIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084078895","type":"CDM"},{"code":"68084078895","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080511","type":"CDM"},{"code":"68084080511","type":"NDC"}],"standard_charges":[{"gross_charge":20.44,"discounted_cash":14.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080521","type":"CDM"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":17.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080801","type":"CDM"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080811","type":"CDM"},{"code":"68084080811","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082725","type":"CDM"},{"code":"68084082725","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082795","type":"CDM"},{"code":"68084082795","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084401","type":"CDM"},{"code":"68084084401","type":"NDC"}],"standard_charges":[{"gross_charge":18.59,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084411","type":"CDM"},{"code":"68084084411","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084501","type":"CDM"},{"code":"68084084501","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084511","type":"CDM"},{"code":"68084084511","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084701","type":"CDM"},{"code":"68084084701","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084711","type":"CDM"},{"code":"68084084711","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087511","type":"CDM"},{"code":"68084087511","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.53,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.44,"discounted_cash":11.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089625","type":"CDM"},{"code":"68084089625","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089695","type":"CDM"},{"code":"68084089695","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084092825","type":"CDM"},{"code":"68084092825","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084092895","type":"CDM"},{"code":"68084092895","type":"NDC"}],"standard_charges":[{"gross_charge":22.11,"discounted_cash":15.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096518","type":"CDM"},{"code":"68084096518","type":"NDC"}],"standard_charges":[{"gross_charge":112.04,"discounted_cash":78.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096519","type":"CDM"},{"code":"68084096519","type":"NDC"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":65.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VALGANCICLOVIR HCL TAB 450 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096595","type":"CDM"},{"code":"68084096595","type":"NDC"}],"standard_charges":[{"gross_charge":181.8,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084096801","type":"CDM"},{"code":"68084096801","type":"NDC"}],"standard_charges":[{"gross_charge":18.44,"discounted_cash":12.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":17.07,"discounted_cash":11.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099601","type":"CDM"},{"code":"68084099601","type":"NDC"}],"standard_charges":[{"gross_charge":19.3,"discounted_cash":13.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099611","type":"CDM"},{"code":"68084099611","type":"NDC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094000162","type":"CDM"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":17.32,"discounted_cash":12.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL ORAL SOLN 1 MG/ML (5 MG/5ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094000459","type":"CDM"},{"code":"68094000459","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL ORAL SOLN 1 MG/ML (5 MG/5ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094000462","type":"CDM"},{"code":"68094000462","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001859","type":"CDM"},{"code":"68094001859","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001861","type":"CDM"},{"code":"68094001861","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001959","type":"CDM"},{"code":"68094001959","type":"NDC"}],"standard_charges":[{"gross_charge":20.36,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUANFACINE HCL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001962","type":"CDM"},{"code":"68094001962","type":"NDC"}],"standard_charges":[{"gross_charge":20.56,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094003159","type":"CDM"},{"code":"68094003159","type":"NDC"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHADONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094003162","type":"CDM"},{"code":"68094003162","type":"NDC"}],"standard_charges":[{"gross_charge":24.32,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094003459","type":"CDM"},{"code":"68094003459","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094003464","type":"CDM"},{"code":"68094003464","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094004959","type":"CDM"},{"code":"68094004959","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094004962","type":"CDM"},{"code":"68094004962","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094006359","type":"CDM"},{"code":"68094006359","type":"NDC"}],"standard_charges":[{"gross_charge":24.79,"discounted_cash":17.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094006361","type":"CDM"},{"code":"68094006361","type":"NDC"}],"standard_charges":[{"gross_charge":24.72,"discounted_cash":17.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094010120","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"68094010120","type":"NDC"}],"standard_charges":[{"gross_charge":2552.65,"discounted_cash":1786.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.63,"discounted_cash":13.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094035601","type":"CDM"},{"code":"68094035601","type":"NDC"}],"standard_charges":[{"gross_charge":18.59,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094035658","type":"CDM"},{"code":"68094035658","type":"NDC"}],"standard_charges":[{"gross_charge":18.86,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094050359","type":"CDM"},{"code":"68094050359","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094050361","type":"CDM"},{"code":"68094050361","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094050362","type":"CDM"},{"code":"68094050362","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":106.78,"discounted_cash":74.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":129.84,"discounted_cash":90.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076459","type":"CDM"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":17.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076462","type":"CDM"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029407","type":"CDM"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029509","type":"CDM"},{"code":"68180029509","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030220","type":"CDM"},{"code":"68180030220","type":"NDC"}],"standard_charges":[{"gross_charge":22.47,"discounted_cash":15.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031906","type":"CDM"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180031909","type":"CDM"},{"code":"68180031909","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035209","type":"CDM"},{"code":"68180035209","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035309","type":"CDM"},{"code":"68180035309","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx68180042201","type":"CDM"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":123.63,"discounted_cash":86.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68180044102","type":"CDM"},{"code":"68180044102","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051301","type":"CDM"},{"code":"68180051301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE MONOHYDRATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065208","type":"CDM"},{"code":"68180065208","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":10.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065806","type":"CDM"},{"code":"68180065806","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065906","type":"CDM"},{"code":"68180065906","type":"NDC"}],"standard_charges":[{"gross_charge":17.48,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.6,"discounted_cash":14.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":20.59,"discounted_cash":14.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx68180067801","type":"CDM"},{"code":"68180067801","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":16.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":62.58,"discounted_cash":43.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":0.00018,"type":"GM"},"code_information":[{"code":"Rx68180096301","type":"CDM"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096501","type":"CDM"},{"code":"68180096501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096601","type":"CDM"},{"code":"68180096601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096809","type":"CDM"},{"code":"68180096809","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096901","type":"CDM"},{"code":"68180096901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096909","type":"CDM"},{"code":"68180096909","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180097301","type":"CDM"},{"code":"68180097301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098001","type":"CDM"},{"code":"68180098001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098101","type":"CDM"},{"code":"68180098101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098103","type":"CDM"},{"code":"68180098103","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":73.3,"discounted_cash":51.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LAMOTRIGINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382001014","type":"CDM"},{"code":"68382001014","type":"NDC"}],"standard_charges":[{"gross_charge":15.39,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382007901","type":"CDM"},{"code":"68382007901","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009201","type":"CDM"},{"code":"68382009201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009301","type":"CDM"},{"code":"68382009301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARVEDILOL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382009401","type":"CDM"},{"code":"68382009401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011214","type":"CDM"},{"code":"68382011214","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382013814","type":"CDM"},{"code":"68382013814","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382019616","type":"CDM"},{"code":"68382019616","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68382044405","type":"CDM"},{"code":"68382044405","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":18.05,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382059616","type":"CDM"},{"code":"68382059616","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":11.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382066001","type":"CDM"},{"code":"68382066001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":143.43,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68382086010","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":140.74,"discounted_cash":98.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091001","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091001","type":"NDC"}],"standard_charges":[{"gross_charge":228.4,"discounted_cash":159.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091010","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"gross_charge":127.53,"discounted_cash":89.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010340","type":"CDM"},{"code":"68462010340","type":"NDC"}],"standard_charges":[{"gross_charge":23.77,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462012801","type":"CDM"},{"code":"68462012801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.08,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015740","type":"CDM"},{"code":"68462015740","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462026290","type":"CDM"},{"code":"68462026290","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029301","type":"CDM"},{"code":"68462029301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462033290","type":"CDM"},{"code":"68462033290","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040560","type":"CDM"},{"code":"68462040560","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":12.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462046840","type":"CDM"},{"code":"68462046840","type":"NDC"}],"standard_charges":[{"gross_charge":21.43,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462046940","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462046940","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462046954","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462046954","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462047040","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462047040","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462047054","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062102","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062154","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062154","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062210","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062264","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062264","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462063925","type":"CDM"},{"code":"68462063925","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462063945","type":"CDM"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx68462074635","type":"CDM"},{"code":"68462074635","type":"NDC"}],"standard_charges":[{"gross_charge":206.65,"discounted_cash":144.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx68462089701","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"68462089701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 500 MCG/ML (0.5 MG/ML)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx68462089710","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"68462089710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx68462094612","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"68462094612","type":"NDC"}],"standard_charges":[{"gross_charge":231.73,"discounted_cash":162.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":336.22,"discounted_cash":235.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM CHLORIDE TAB DR 64 MG (ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000575","type":"CDM"},{"code":"68585000575","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682065220","type":"CDM"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"gross_charge":942.96,"discounted_cash":660.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LURBINECTEDIN FOR IV SOLN 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68727071201","type":"CDM"},{"code":"J9223","type":"HCPCS"},{"code":"68727071201","type":"NDC"}],"standard_charges":[{"gross_charge":50894.25,"discounted_cash":35625.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRYPAN BLUE INTRAOCULAR SOLN PREF SYR 0.06%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68803061210","type":"CDM"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":445.85,"discounted_cash":312.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":10804.16,"discounted_cash":7562.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":3432.98,"discounted_cash":2403.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026181","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026181","type":"NDC"}],"standard_charges":[{"gross_charge":3731.5,"discounted_cash":2612.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097000467","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"69097000467","type":"NDC"}],"standard_charges":[{"gross_charge":128.04,"discounted_cash":89.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097012705","type":"CDM"},{"code":"69097012705","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69097031832","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031832","type":"NDC"}],"standard_charges":[{"gross_charge":28.71,"discounted_cash":20.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.25 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69097031853","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031853","type":"NDC"}],"standard_charges":[{"gross_charge":75.54,"discounted_cash":52.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097031932","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031932","type":"NDC"}],"standard_charges":[{"gross_charge":35.47,"discounted_cash":24.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69097031953","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"69097031953","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097039878","type":"CDM"},{"code":"J9264","type":"HCPCS"},{"code":"69097039878","type":"NDC"}],"standard_charges":[{"gross_charge":5847.14,"discounted_cash":4093.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097041002","type":"CDM"},{"code":"69097041002","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097042107","type":"CDM"},{"code":"69097042107","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097042207","type":"CDM"},{"code":"69097042207","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EMTRICITABINE CAPS 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097064202","type":"CDM"},{"code":"69097064202","type":"NDC"}],"standard_charges":[{"gross_charge":129.48,"discounted_cash":90.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69097070831","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070831","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69097070896","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69097070930","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070930","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097081307","type":"CDM"},{"code":"69097081307","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097086107","type":"CDM"},{"code":"69097086107","type":"NDC"}],"standard_charges":[{"gross_charge":15.79,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238126401","type":"CDM"},{"code":"69238126401","type":"NDC"}],"standard_charges":[{"gross_charge":76.24,"discounted_cash":53.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131009","type":"CDM"},{"code":"69238131009","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131209","type":"CDM"},{"code":"69238131209","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TETRACYCLINE HCL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238152201","type":"CDM"},{"code":"69238152201","type":"NDC"}],"standard_charges":[{"gross_charge":19.76,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOCINONIDE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69238153405","type":"CDM"},{"code":"69238153405","type":"NDC"}],"standard_charges":[{"gross_charge":152.68,"discounted_cash":106.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238160508","type":"CDM"},{"code":"69238160508","type":"NDC"}],"standard_charges":[{"gross_charge":135.4,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx69238174608","type":"CDM"},{"code":"69238174608","type":"NDC"}],"standard_charges":[{"gross_charge":521.39,"discounted_cash":364.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx69238201603","type":"CDM"},{"code":"69238201603","type":"NDC"}],"standard_charges":[{"gross_charge":196.26,"discounted_cash":137.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238207701","type":"CDM"},{"code":"69238207701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":291.06,"discounted_cash":203.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315011601","type":"CDM"},{"code":"69315011601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315011701","type":"CDM"},{"code":"69315011701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315012701","type":"CDM"},{"code":"69315012701","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315013701","type":"CDM"},{"code":"69315013701","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69315030615","type":"CDM"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":55.73,"discounted_cash":39.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":54.61,"discounted_cash":38.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":82.28,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx69315032308","type":"CDM"},{"code":"69315032308","type":"NDC"}],"standard_charges":[{"gross_charge":145.14,"discounted_cash":101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315091001","type":"CDM"},{"code":"69315091001","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":10.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69339013634","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":61.64,"discounted_cash":43.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx69339013693","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013693","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx69339013697","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013697","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015001","type":"CDM"},{"code":"69339015001","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339015019","type":"CDM"},{"code":"69339015019","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339016001","type":"CDM"},{"code":"69339016001","type":"NDC"}],"standard_charges":[{"gross_charge":24.1,"discounted_cash":16.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339016016","type":"CDM"},{"code":"69339016016","type":"NDC"}],"standard_charges":[{"gross_charge":26.97,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339016017","type":"CDM"},{"code":"69339016017","type":"NDC"}],"standard_charges":[{"gross_charge":24.57,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOMETHACIN SUPPOS 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69344010233","type":"CDM"},{"code":"69344010233","type":"NDC"}],"standard_charges":[{"gross_charge":1041.6,"discounted_cash":729.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367022001","type":"CDM"},{"code":"69367022001","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69367034001","type":"CDM"},{"code":"69367034001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.93,"discounted_cash":11.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":16.93,"discounted_cash":11.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452015773","type":"CDM"},{"code":"69452015773","type":"NDC"}],"standard_charges":[{"gross_charge":18.67,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 10 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452015774","type":"CDM"},{"code":"69452015774","type":"NDC"}],"standard_charges":[{"gross_charge":18.66,"discounted_cash":13.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452020907","type":"CDM"},{"code":"69452020907","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":12.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIMODIPINE CAP 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452020920","type":"CDM"},{"code":"69452020920","type":"NDC"}],"standard_charges":[{"gross_charge":19.18,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69452027120","type":"CDM"},{"code":"69452027120","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL ORAL LIQUID 10 MCG/ML (400 UNIT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69618001959","type":"CDM"},{"code":"69618001959","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69618005801","type":"CDM"},{"code":"69618005801","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSNETUPITANT-PALONOSETRON IV SOLN 235-0.25 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx69639010501","type":"CDM"},{"code":"J1454","type":"HCPCS"},{"code":"69639010501","type":"NDC"}],"standard_charges":[{"gross_charge":4200.91,"discounted_cash":2940.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69784000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"69784000206","type":"NDC"}],"standard_charges":[{"gross_charge":46.8,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM ACETATE INJ 2 MEQ/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx69784023010","type":"CDM"},{"code":"69784023010","type":"NDC"}],"standard_charges":[{"gross_charge":104.36,"discounted_cash":73.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":99.1,"discounted_cash":69.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073101","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073101","type":"NDC"}],"standard_charges":[{"gross_charge":931.9,"discounted_cash":652.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69918073110","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"69918073110","type":"NDC"}],"standard_charges":[{"gross_charge":449.34,"discounted_cash":314.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDIUM IN-111 PENTETREOTIDE KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69945005040","type":"CDM"},{"code":"A9572","type":"HCPCS"},{"code":"69945005040","type":"NDC"}],"standard_charges":[{"gross_charge":23304.72,"discounted_cash":16313.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx70000005101","type":"CDM"},{"code":"70000005101","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM PHOSPHATES - ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx70000010801","type":"CDM"},{"code":"70000010801","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINERAL OIL ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx70000010901","type":"CDM"},{"code":"70000010901","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000014804","type":"CDM"},{"code":"70000014804","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TROLAMINE SALICYLATE CREAM 10%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx70000016901","type":"CDM"},{"code":"70000016901","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER SUPPOS 0.25-88.44%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000022301","type":"CDM"},{"code":"70000022301","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":71.0,"type":"GM"},"code_information":[{"code":"Rx70000032301","type":"CDM"},{"code":"70000032301","type":"NDC"}],"standard_charges":[{"gross_charge":22.57,"discounted_cash":15.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WITCH HAZEL (HAMAMELIS VIRGINIANA) CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000036401","type":"CDM"},{"code":"70000036401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx70000038801","type":"CDM"},{"code":"70000038801","type":"NDC"}],"standard_charges":[{"gross_charge":7.22,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CAFFEINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000040901","type":"CDM"},{"code":"70000040901","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx70000041801","type":"CDM"},{"code":"70000041801","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCERIN SUPPOS 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000042901","type":"CDM"},{"code":"70000042901","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000043401","type":"CDM"},{"code":"70000043401","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx70000044801","type":"CDM"},{"code":"70000044801","type":"NDC"}],"standard_charges":[{"gross_charge":25.54,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx70000048501","type":"CDM"},{"code":"70000048501","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70000049001","type":"CDM"},{"code":"70000049001","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000052601","type":"CDM"},{"code":"70000052601","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx70000055501","type":"CDM"},{"code":"70000055501","type":"NDC"}],"standard_charges":[{"gross_charge":28.8,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000057302","type":"CDM"},{"code":"70000057302","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"Rx70000065901","type":"CDM"},{"code":"70000065901","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":71.0,"type":"GM"},"code_information":[{"code":"Rx70000067901","type":"CDM"},{"code":"70000067901","type":"NDC"}],"standard_charges":[{"gross_charge":22.57,"discounted_cash":15.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010000201","type":"CDM"},{"code":"70010000201","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006301","type":"CDM"},{"code":"70010006301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006501","type":"CDM"},{"code":"70010006501","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010010801","type":"CDM"},{"code":"70010010801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010011301","type":"CDM"},{"code":"70010011301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 7.5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010066901","type":"CDM"},{"code":"70010066901","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010075401","type":"CDM"},{"code":"70010075401","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010077001","type":"CDM"},{"code":"70010077001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010078101","type":"CDM"},{"code":"70010078101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IXABEPILONE FOR IV INFUSION 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70020191001","type":"CDM"},{"code":"J9207","type":"HCPCS"},{"code":"70020191001","type":"NDC"}],"standard_charges":[{"gross_charge":14292.01,"discounted_cash":10004.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IXABEPILONE FOR IV INFUSION 45 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70020191101","type":"CDM"},{"code":"J9207","type":"HCPCS"},{"code":"70020191101","type":"NDC"}],"standard_charges":[{"gross_charge":37283.45,"discounted_cash":26098.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70069000501","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70069000501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70069000510","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069001701","type":"CDM"},{"code":"70069001701","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":20.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70069002101","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":26.42,"discounted_cash":18.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.2,"type":"ML"},"code_information":[{"code":"Rx70069002101","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069002125","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":14.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006201","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006210","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006401","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006410","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006410","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069006425","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007201","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 4 MG/10ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069007210","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007210","type":"NDC"}],"standard_charges":[{"gross_charge":56.67,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069010105","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"70069010105","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHOCARBAMOL INJ 1000 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069010125","type":"CDM"},{"code":"J2800","type":"HCPCS"},{"code":"70069010125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069013101","type":"CDM"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":51.57,"discounted_cash":36.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069014101","type":"CDM"},{"code":"70069014101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069014110","type":"CDM"},{"code":"70069014110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069018101","type":"CDM"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":258.77,"discounted_cash":181.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069023101","type":"CDM"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70069026101","type":"CDM"},{"code":"70069026101","type":"NDC"}],"standard_charges":[{"gross_charge":93.04,"discounted_cash":65.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027101","type":"CDM"},{"code":"70069027101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069031101","type":"CDM"},{"code":"70069031101","type":"NDC"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":27.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069036201","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069036210","type":"CDM"},{"code":"J2865","type":"HCPCS"},{"code":"70069036210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069042101","type":"CDM"},{"code":"70069042101","type":"NDC"}],"standard_charges":[{"gross_charge":47.4,"discounted_cash":33.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069050101","type":"CDM"},{"code":"70069050101","type":"NDC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069058201","type":"CDM"},{"code":"70069058201","type":"NDC"}],"standard_charges":[{"gross_charge":206.5,"discounted_cash":144.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069061701","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70069061701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069061725","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70069061725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069072701","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"70069072701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069072710","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"70069072710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069072725","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"70069072725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069080401","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"70069080401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069080405","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"70069080405","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70069080801","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"70069080801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70069080810","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"70069080810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70069081601","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"70069081601","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70069081610","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"70069081610","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70092106807","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092106807","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":53.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70092108644","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092108644","type":"NDC"}],"standard_charges":[{"gross_charge":221.52,"discounted_cash":155.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70092109236","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70092109236","type":"NDC"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092110436","type":"CDM"},{"code":"70092110436","type":"NDC"}],"standard_charges":[{"gross_charge":102.97,"discounted_cash":72.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 0.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70092113243","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"70092113243","type":"NDC"}],"standard_charges":[{"gross_charge":37.95,"discounted_cash":26.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL-SODIUM BICARB LOCAL SOLN PREF SYR 1-8.4%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70092117546","type":"CDM"},{"code":"70092117546","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL 0.2 MG/100ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL-BUPIVACAINE 2 MCG-0.125 %,FENTANYL 0.5 MG/250ML-BUPIV 0.125%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.1 MG/50ML-BUPIV 0.125%-NACL 0.9% EPIDURAL SYR,FENTANYL CITRATE 2 MCG/ML-BUPIVACAINE 0.125% EPIDURAL INJ","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092120275","type":"CDM"},{"code":"70092120275","type":"NDC"}],"standard_charges":[{"gross_charge":357.07,"discounted_cash":249.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":577.22,"discounted_cash":404.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70092165844","type":"CDM"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":98.92,"discounted_cash":69.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002401","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"70095002401","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002402","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"70095002402","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002501","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70095002501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002502","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70095002502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70095002601","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"70095002601","type":"NDC"}],"standard_charges":[{"gross_charge":105.84,"discounted_cash":74.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70095002602","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"70095002602","type":"NDC"}],"standard_charges":[{"gross_charge":105.5,"discounted_cash":73.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INDOCYANINE GREEN FOR INJ SOLN 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70100072501","type":"CDM"},{"code":"70100072501","type":"NDC"}],"standard_charges":[{"gross_charge":2412.4,"discounted_cash":1688.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1651.6,"discounted_cash":1156.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGFILGRASTIM-CBQV SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx70114010101","type":"CDM"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"gross_charge":11110.1,"discounted_cash":7777.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121116901","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121116901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70121118901","type":"CDM"},{"code":"70121118901","type":"NDC"}],"standard_charges":[{"gross_charge":150.93,"discounted_cash":105.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70121147901","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70121147901","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70121147907","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70121147907","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121156801","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156801","type":"NDC"}],"standard_charges":[{"gross_charge":996.64,"discounted_cash":697.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121156807","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156807","type":"NDC"}],"standard_charges":[{"gross_charge":996.65,"discounted_cash":697.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157001","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157001","type":"NDC"}],"standard_charges":[{"gross_charge":1308.36,"discounted_cash":915.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157007","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157007","type":"NDC"}],"standard_charges":[{"gross_charge":1308.34,"discounted_cash":915.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70121157301","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70121157305","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":63.4,"discounted_cash":44.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx70121157807","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157807","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172001","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121172009","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70214501001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"70214501001","type":"NDC"}],"standard_charges":[{"gross_charge":110.63,"discounted_cash":77.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377001411","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"70377001411","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70377011311","type":"CDM"},{"code":"70377011311","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377011412","type":"CDM"},{"code":"70377011412","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIOTHYRONINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70377011512","type":"CDM"},{"code":"70377011512","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70377012111","type":"CDM"},{"code":"70377012111","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx70377012112","type":"CDM"},{"code":"70377012112","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CINACALCET HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436000704","type":"CDM"},{"code":"70436000704","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DESVENLAFAXINE SUCCINATE TAB ER 24HR 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001304","type":"CDM"},{"code":"70436001304","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":13.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001982","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002082","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002182","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002580","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"70436002580","type":"NDC"}],"standard_charges":[{"gross_charge":617.38,"discounted_cash":432.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002582","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"70436002582","type":"NDC"}],"standard_charges":[{"gross_charge":408.25,"discounted_cash":285.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":601.16,"discounted_cash":420.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002980","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"70436002980","type":"NDC"}],"standard_charges":[{"gross_charge":126.63,"discounted_cash":88.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.14,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436005901","type":"CDM"},{"code":"70436005901","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436009205","type":"CDM"},{"code":"70436009205","type":"NDC"}],"standard_charges":[{"gross_charge":37.18,"discounted_cash":26.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436011036","type":"CDM"},{"code":"70436011036","type":"NDC"}],"standard_charges":[{"gross_charge":536.57,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436011056","type":"CDM"},{"code":"70436011056","type":"NDC"}],"standard_charges":[{"gross_charge":465.6,"discounted_cash":325.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70436014780","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"70436014780","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":49.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70436014781","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"70436014781","type":"NDC"}],"standard_charges":[{"gross_charge":59.39,"discounted_cash":41.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436020201","type":"CDM"},{"code":"70436020201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065503","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065503","type":"NDC"}],"standard_charges":[{"gross_charge":270.89,"discounted_cash":189.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":270.89,"discounted_cash":189.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN (HUMAN) INJ 5000 UNIT/4.4ML","drug_information":{"unit":4.4,"type":"ML"},"code_information":[{"code":"Rx70504310002","type":"CDM"},{"code":"J2792","type":"HCPCS"},{"code":"70504310002","type":"NDC"}],"standard_charges":[{"gross_charge":5764.02,"discounted_cash":4034.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OLOPATADINE HCL OPHTH SOLN 0.1% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70512052005","type":"CDM"},{"code":"70512052005","type":"NDC"}],"standard_charges":[{"gross_charge":40.68,"discounted_cash":28.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70512084001","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70512084001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70512084025","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70515026010","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"70515026010","type":"NDC"}],"standard_charges":[{"gross_charge":1102.11,"discounted_cash":771.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594004501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594004501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594004502","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594004502","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011101","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011101","type":"NDC"}],"standard_charges":[{"gross_charge":260.78,"discounted_cash":182.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011102","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011102","type":"NDC"}],"standard_charges":[{"gross_charge":224.39,"discounted_cash":157.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012202","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70655000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx70655000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":231.16,"discounted_cash":161.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70655000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":47.65,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx70655000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":95.31,"discounted_cash":66.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70700012692","type":"CDM"},{"code":"70700012692","type":"NDC"}],"standard_charges":[{"gross_charge":146.02,"discounted_cash":102.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700017222","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70700017222","type":"NDC"}],"standard_charges":[{"gross_charge":145.93,"discounted_cash":102.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70700017223","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"70700017223","type":"NDC"}],"standard_charges":[{"gross_charge":43.49,"discounted_cash":30.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70700018722","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018722","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70700018723","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018723","type":"NDC"}],"standard_charges":[{"gross_charge":149.32,"discounted_cash":104.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70700018822","type":"CDM"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70700024922","type":"CDM"},{"code":"70700024922","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70700024925","type":"CDM"},{"code":"70700024925","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70700026894","type":"CDM"},{"code":"70700026894","type":"NDC"}],"standard_charges":[{"gross_charge":239.64,"discounted_cash":167.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TESTOSTERONE CYPIONATE IM INJ IN OIL 200 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70700028922","type":"CDM"},{"code":"J1071","type":"HCPCS"},{"code":"70700028922","type":"NDC"}],"standard_charges":[{"gross_charge":34.84,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRABEGRON TAB ER 24 HR 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710115903","type":"CDM"},{"code":"70710115903","type":"NDC"}],"standard_charges":[{"gross_charge":111.17,"discounted_cash":77.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710135901","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710135901","type":"NDC"}],"standard_charges":[{"gross_charge":128.75,"discounted_cash":90.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710135906","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710135906","type":"NDC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":14.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx70710137702","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"70710137702","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70710146301","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"70710146301","type":"NDC"}],"standard_charges":[{"gross_charge":56.21,"discounted_cash":39.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70710146305","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"70710146305","type":"NDC"}],"standard_charges":[{"gross_charge":58.73,"discounted_cash":41.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx70710147801","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":3402.46,"discounted_cash":2381.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL SUSP (FOR IV INFUSION) 2 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70710153001","type":"CDM"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153001","type":"NDC"}],"standard_charges":[{"gross_charge":1774.6,"discounted_cash":1242.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710160901","type":"CDM"},{"code":"70710160901","type":"NDC"}],"standard_charges":[{"gross_charge":16.44,"discounted_cash":11.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70710164301","type":"CDM"},{"code":"70710164301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70710164307","type":"CDM"},{"code":"70710164307","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710165501","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"70710165501","type":"NDC"}],"standard_charges":[{"gross_charge":6775.84,"discounted_cash":4743.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710171001","type":"CDM"},{"code":"70710171001","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710172401","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"70710172401","type":"NDC"}],"standard_charges":[{"gross_charge":380.64,"discounted_cash":266.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710172406","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"70710172406","type":"NDC"}],"standard_charges":[{"gross_charge":380.34,"discounted_cash":266.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710183301","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"70710183301","type":"NDC"}],"standard_charges":[{"gross_charge":495.61,"discounted_cash":346.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70710183801","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183801","type":"NDC"}],"standard_charges":[{"gross_charge":1521.46,"discounted_cash":1065.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70710183805","type":"CDM"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183805","type":"NDC"}],"standard_charges":[{"gross_charge":803.95,"discounted_cash":562.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 3.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095036","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095036","type":"NDC"}],"standard_charges":[{"gross_charge":8342.74,"discounted_cash":5839.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GOSERELIN ACETATE IMPLANT 10.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70720095130","type":"CDM"},{"code":"J9202","type":"HCPCS"},{"code":"70720095130","type":"NDC"}],"standard_charges":[{"gross_charge":19076.4,"discounted_cash":13353.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70748026101","type":"CDM"},{"code":"70748026101","type":"NDC"}],"standard_charges":[{"gross_charge":38.71,"discounted_cash":27.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FORMOTEROL FUMARATE SOLN NEBU 20 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70748026160","type":"CDM"},{"code":"70748026160","type":"NDC"}],"standard_charges":[{"gross_charge":38.71,"discounted_cash":27.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70752010710","type":"CDM"},{"code":"70752010710","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":89.78,"discounted_cash":62.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIDODRINE HCL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001011","type":"CDM"},{"code":"70756001011","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORTHALIDONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001111","type":"CDM"},{"code":"70756001111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001402","type":"CDM"},{"code":"70756001402","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001405","type":"CDM"},{"code":"70756001405","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756020111","type":"CDM"},{"code":"70756020111","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756020511","type":"CDM"},{"code":"70756020511","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756021490","type":"CDM"},{"code":"70756021490","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756040411","type":"CDM"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN NEBU SOLN 300 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756060456","type":"CDM"},{"code":"J7682","type":"HCPCS"},{"code":"70756060456","type":"NDC"}],"standard_charges":[{"gross_charge":70.86,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060525","type":"CDM"},{"code":"70756060525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756060582","type":"CDM"},{"code":"70756060582","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OFLOXACIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756060730","type":"CDM"},{"code":"70756060730","type":"NDC"}],"standard_charges":[{"gross_charge":99.2,"discounted_cash":69.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061125","type":"CDM"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061182","type":"CDM"},{"code":"70756061182","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756061610","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"70756061610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756061681","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"70756061681","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70756062925","type":"CDM"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":144.46,"discounted_cash":101.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064025","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064082","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064082","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064125","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064185","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"70756064185","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064525","type":"CDM"},{"code":"70756064525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064586","type":"CDM"},{"code":"70756064586","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064825","type":"CDM"},{"code":"70756064825","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064887","type":"CDM"},{"code":"70756064887","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756065225","type":"CDM"},{"code":"70756065225","type":"NDC"}],"standard_charges":[{"gross_charge":359.15,"discounted_cash":251.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756065810","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70756065810","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756065882","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70756065882","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx70756066199","type":"CDM"},{"code":"70756066199","type":"NDC"}],"standard_charges":[{"gross_charge":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RANOLAZINE TAB ER 12HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756070360","type":"CDM"},{"code":"70756070360","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860021141","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"70860021141","type":"NDC"}],"standard_charges":[{"gross_charge":3456.31,"discounted_cash":2419.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860021174","type":"CDM"},{"code":"J9395","type":"HCPCS"},{"code":"70860021174","type":"NDC"}],"standard_charges":[{"gross_charge":655.48,"discounted_cash":458.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx70860021568","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"70860021568","type":"NDC"}],"standard_charges":[{"gross_charge":437.37,"discounted_cash":306.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860021805","type":"CDM"},{"code":"J9073","type":"HCPCS"},{"code":"70860021805","type":"NDC"}],"standard_charges":[{"gross_charge":1161.43,"discounted_cash":813.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860030105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030105","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx70860030125","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030125","type":"NDC"}],"standard_charges":[{"gross_charge":48.67,"discounted_cash":34.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860030141","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030141","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx70860030143","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860030143","type":"NDC"}],"standard_charges":[{"gross_charge":48.67,"discounted_cash":34.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860040610","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70860040610","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860040641","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"70860040641","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860045110","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"70860045110","type":"NDC"}],"standard_charges":[{"gross_charge":555.83,"discounted_cash":389.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077802","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70860077802","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077841","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70860077841","type":"NDC"}],"standard_charges":[{"gross_charge":55.84,"discounted_cash":39.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954005910","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"70954005910","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREDNISONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954006110","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"70954006110","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954021110","type":"CDM"},{"code":"70954021110","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954021210","type":"CDM"},{"code":"70954021210","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70954025810","type":"CDM"},{"code":"70954025810","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":12.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70954031610","type":"CDM"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MISOPROSTOL TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044310","type":"CDM"},{"code":"70954044310","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BISOPROLOL FUMARATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954045520","type":"CDM"},{"code":"70954045520","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PYRAZINAMIDE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954048410","type":"CDM"},{"code":"70954048410","type":"NDC"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954056410","type":"CDM"},{"code":"70954056410","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"C1 ESTERASE INHIBITOR (RECOMBINANT) FOR IV INJ 2100 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71274035001","type":"CDM"},{"code":"J0596","type":"HCPCS"},{"code":"71274035001","type":"NDC"}],"standard_charges":[{"gross_charge":28567.04,"discounted_cash":19996.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001615","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":124.79,"discounted_cash":87.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002320","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002320","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002321","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003220","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003220","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003221","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003221","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288010110","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BLEOMYCIN SULFATE FOR INJ 15 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288010610","type":"CDM"},{"code":"J9040","type":"HCPCS"},{"code":"71288010610","type":"NDC"}],"standard_charges":[{"gross_charge":289.62,"discounted_cash":202.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288011530","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"71288011530","type":"NDC"}],"standard_charges":[{"gross_charge":221.72,"discounted_cash":155.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.26,"type":"ML"},"code_information":[{"code":"Rx71288011706","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV)","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"Rx71288011728","type":"CDM"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":115.91,"discounted_cash":81.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BORTEZOMIB FOR INJ 3.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288011810","type":"CDM"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":201.22,"discounted_cash":140.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 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":3163.54,"discounted_cash":2214.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx71288014416","type":"CDM"},{"code":"J9171","type":"HCPCS"},{"code":"71288014416","type":"NDC"}],"standard_charges":[{"gross_charge":1224.09,"discounted_cash":856.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OXALIPLATIN IV SOLN 50 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288014995","type":"CDM"},{"code":"J9263","type":"HCPCS"},{"code":"71288014995","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEUCOVORIN CALCIUM FOR INJ 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016330","type":"CDM"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":174.93,"discounted_cash":122.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 100 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016610","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016610","type":"NDC"}],"standard_charges":[{"gross_charge":118.17,"discounted_cash":82.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMETREXED DISODIUM FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288016750","type":"CDM"},{"code":"J9305","type":"HCPCS"},{"code":"71288016750","type":"NDC"}],"standard_charges":[{"gross_charge":574.65,"discounted_cash":402.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ETOPOSIDE INJ 100 MG/5ML (20 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288017505","type":"CDM"},{"code":"J9181","type":"HCPCS"},{"code":"71288017505","type":"NDC"}],"standard_charges":[{"gross_charge":116.58,"discounted_cash":81.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx71288020020","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"71288020020","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx71288020021","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"71288020021","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288020185","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":130.67,"discounted_cash":91.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288020202","type":"CDM"},{"code":"71288020202","type":"NDC"}],"standard_charges":[{"gross_charge":100.06,"discounted_cash":70.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020302","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020302","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020303","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020304","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020304","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020305","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020310","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020311","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020311","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx71288030301","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"71288030301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx71288030302","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040002","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040002","type":"NDC"}],"standard_charges":[{"gross_charge":57.05,"discounted_cash":39.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040003","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040003","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288040201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,HEPARIN SODIUM (PORCINE) PF INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040202","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288040211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx71288040301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx71288040302","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288041080","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041080","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288041081","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041081","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288041088","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041088","type":"NDC"}],"standard_charges":[{"gross_charge":56.69,"discounted_cash":39.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288041089","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041089","type":"NDC"}],"standard_charges":[{"gross_charge":56.11,"discounted_cash":39.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288041182","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041182","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288041183","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041183","type":"NDC"}],"standard_charges":[{"gross_charge":159.04,"discounted_cash":111.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288041210","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"71288041210","type":"NDC"}],"standard_charges":[{"gross_charge":159.35,"discounted_cash":111.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx71288041351","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"71288041351","type":"NDC"}],"standard_charges":[{"gross_charge":474.54,"discounted_cash":332.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288042710","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"71288042710","type":"NDC"}],"standard_charges":[{"gross_charge":370.87,"discounted_cash":259.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE FOR IV SOLN 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288042711","type":"CDM"},{"code":"J0583","type":"HCPCS"},{"code":"71288042711","type":"NDC"}],"standard_charges":[{"gross_charge":370.6,"discounted_cash":259.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288043280","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043280","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288043281","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043382","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043382","type":"NDC"}],"standard_charges":[{"gross_charge":48.93,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043383","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288043484","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043484","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288043485","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx71288043586","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043586","type":"NDC"}],"standard_charges":[{"gross_charge":52.08,"discounted_cash":36.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx71288043587","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":52.81,"discounted_cash":36.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288043688","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043688","type":"NDC"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":47.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288043689","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043689","type":"NDC"}],"standard_charges":[{"gross_charge":68.41,"discounted_cash":47.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx71288043791","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043791","type":"NDC"}],"standard_charges":[{"gross_charge":68.58,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx71288043792","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043792","type":"NDC"}],"standard_charges":[{"gross_charge":82.91,"discounted_cash":58.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288043893","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043893","type":"NDC"}],"standard_charges":[{"gross_charge":159.05,"discounted_cash":111.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288043894","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043894","type":"NDC"}],"standard_charges":[{"gross_charge":98.67,"discounted_cash":69.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288050110","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"71288050110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx71288050111","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"71288050111","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060010","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060011","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288071205","type":"CDM"},{"code":"71288071205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288071206","type":"CDM"},{"code":"71288071206","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx71288071910","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"71288071910","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx71288071911","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288073530","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"71288073530","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71288073531","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"71288073531","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288080320","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"71288080320","type":"NDC"}],"standard_charges":[{"gross_charge":712.69,"discounted_cash":498.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL HCL FOR IV SOLN 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288080321","type":"CDM"},{"code":"J7519","type":"HCPCS"},{"code":"71288080321","type":"NDC"}],"standard_charges":[{"gross_charge":141.32,"discounted_cash":98.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288080701","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx71288080701","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx71288080702","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080702","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288080702","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"71288080702","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PATISIRAN SODIUM IV SOLN 10 MG/5ML (2 MG/ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71336100001","type":"CDM"},{"code":"J0222","type":"HCPCS"},{"code":"71336100001","type":"NDC"}],"standard_charges":[{"gross_charge":50046.0,"discounted_cash":35032.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GIVOSIRAN SODIUM SUBCUTANEOUS SOLN 189 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71336100101","type":"CDM"},{"code":"J0223","type":"HCPCS"},{"code":"71336100101","type":"NDC"}],"standard_charges":[{"gross_charge":171210.0,"discounted_cash":119847.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VUTRISIRAN SODIUM SOLN PREFILLED SYRINGE 25 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71336100301","type":"CDM"},{"code":"J0225","type":"HCPCS"},{"code":"71336100301","type":"NDC"}],"standard_charges":[{"gross_charge":523950.89,"discounted_cash":366765.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71351002202","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"71351002202","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71351002210","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"71351002210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71351002305","type":"CDM"},{"code":"71351002305","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71351002310","type":"CDM"},{"code":"71351002310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL 0.2% ON-Q SINGLE LUMEN PUMP","drug_information":{"unit":745.0,"type":"ML"},"code_information":[{"code":"Rx71449007957","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449007957","type":"NDC"}],"standard_charges":[{"gross_charge":3141.35,"discounted_cash":2198.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx71656002101","type":"CDM"},{"code":"71656002101","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx71656002115","type":"CDM"},{"code":"71656002115","type":"NDC"}],"standard_charges":[{"gross_charge":20.44,"discounted_cash":14.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71839012001","type":"CDM"},{"code":"71839012001","type":"NDC"}],"standard_charges":[{"gross_charge":90.5,"discounted_cash":63.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CIPAGLUCOSIDASE ALFA-ATGA FOR IV SOLN 105 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71904020001","type":"CDM"},{"code":"J1203","type":"HCPCS"},{"code":"71904020001","type":"NDC"}],"standard_charges":[{"gross_charge":7761.72,"discounted_cash":5433.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078003400","type":"CDM"},{"code":"72078003400","type":"NDC"}],"standard_charges":[{"gross_charge":467.22,"discounted_cash":327.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078003401","type":"CDM"},{"code":"72078003401","type":"NDC"}],"standard_charges":[{"gross_charge":220.39,"discounted_cash":154.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205001290","type":"CDM"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205004060","type":"CDM"},{"code":"72205004060","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205004411","type":"CDM"},{"code":"72205004411","type":"NDC"}],"standard_charges":[{"gross_charge":22.64,"discounted_cash":15.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBENDAZOLE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205005108","type":"CDM"},{"code":"72205005108","type":"NDC"}],"standard_charges":[{"gross_charge":128.64,"discounted_cash":90.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205005401","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"72205005401","type":"NDC"}],"standard_charges":[{"gross_charge":125.41,"discounted_cash":87.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx72205006301","type":"CDM"},{"code":"J9267","type":"HCPCS"},{"code":"72205006301","type":"NDC"}],"standard_charges":[{"gross_charge":328.82,"discounted_cash":230.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUPHENAZINE DECANOATE INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72205010001","type":"CDM"},{"code":"J2680","type":"HCPCS"},{"code":"72205010001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72205010101","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"72205010101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72205010107","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205010491","type":"CDM"},{"code":"72205010491","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205022001","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72205022001","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":31.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205022007","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"72205022007","type":"NDC"}],"standard_charges":[{"gross_charge":19.31,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205026501","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72205026501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72205026507","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"72205026507","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205028060","type":"CDM"},{"code":"72205028060","type":"NDC"}],"standard_charges":[{"gross_charge":21.31,"discounted_cash":14.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 97-103 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205028260","type":"CDM"},{"code":"72205028260","type":"NDC"}],"standard_charges":[{"gross_charge":21.31,"discounted_cash":14.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72241001103","type":"CDM"},{"code":"72241001103","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72241002405","type":"CDM"},{"code":"72241002405","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":2608.1,"discounted_cash":1825.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72266010201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011801","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72266012201","type":"CDM"},{"code":"72266012201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72266012205","type":"CDM"},{"code":"72266012205","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VORICONAZOLE FOR INJ 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266013101","type":"CDM"},{"code":"J3465","type":"HCPCS"},{"code":"72266013101","type":"NDC"}],"standard_charges":[{"gross_charge":218.65,"discounted_cash":153.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx72266015201","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":811.15,"discounted_cash":567.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZIPRASIDONE MESYLATE FOR INJ 20 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016001","type":"CDM"},{"code":"J3486","type":"HCPCS"},{"code":"72266016001","type":"NDC"}],"standard_charges":[{"gross_charge":130.79,"discounted_cash":91.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":97.82,"discounted_cash":68.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016301","type":"CDM"},{"code":"72266016301","type":"NDC"}],"standard_charges":[{"gross_charge":706.25,"discounted_cash":494.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TOBRAMYCIN SULFATE FOR INJ 1.2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266016306","type":"CDM"},{"code":"72266016306","type":"NDC"}],"standard_charges":[{"gross_charge":741.55,"discounted_cash":519.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72266019701","type":"CDM"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"gross_charge":157.07,"discounted_cash":109.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXRAZOXANE HCL FOR INJ 250 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266023501","type":"CDM"},{"code":"J1190","type":"HCPCS"},{"code":"72266023501","type":"NDC"}],"standard_charges":[{"gross_charge":2359.67,"discounted_cash":1651.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266024801","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"72266024801","type":"NDC"}],"standard_charges":[{"gross_charge":924.53,"discounted_cash":647.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SINCALIDE FOR INJ 5 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72266024805","type":"CDM"},{"code":"J2805","type":"HCPCS"},{"code":"72266024805","type":"NDC"}],"standard_charges":[{"gross_charge":791.29,"discounted_cash":553.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CISPLATIN INJ 100 MG/100ML (1 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx72266025301","type":"CDM"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":342.23,"discounted_cash":239.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010101","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010125","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72485010501","type":"CDM"},{"code":"72485010501","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":67.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AZACITIDINE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485020101","type":"CDM"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":196.91,"discounted_cash":137.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041201","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72485041201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041210","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72485041210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042201","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042201","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":40.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72485050201","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"72485050201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MILRINONE LACTATE IV SOLN 20 MG/20ML (BASE EQUIVALENT)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72485050210","type":"CDM"},{"code":"J2260","type":"HCPCS"},{"code":"72485050210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050701","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"72485050701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72485050725","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"72485050725","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx72485067031","type":"CDM"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":70.47,"discounted_cash":49.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572012201","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012201","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572012225","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"72572012225","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx72572015001","type":"CDM"},{"code":"72572015001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx72572015010","type":"CDM"},{"code":"72572015010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017001","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017001","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017025","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017025","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017101","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017101","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572017125","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"72572017125","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572019001","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"72572019001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572019025","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"72572019025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx72572025501","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"72572025501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx72572025525","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"72572025525","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72572026501","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"72572026501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037201","type":"CDM"},{"code":"72572037201","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037225","type":"CDM"},{"code":"72572037225","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041501","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041510","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041510","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041601","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041601","type":"NDC"}],"standard_charges":[{"gross_charge":62.35,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572041610","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"72572041610","type":"NDC"}],"standard_charges":[{"gross_charge":62.35,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572042001","type":"CDM"},{"code":"72572042001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572042010","type":"CDM"},{"code":"72572042010","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72572048101","type":"CDM"},{"code":"72572048101","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72572048110","type":"CDM"},{"code":"72572048110","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572052001","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72572052001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72572052025","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72572052025","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055301","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055301","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055310","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055310","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572060101","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"72572060101","type":"NDC"}],"standard_charges":[{"gross_charge":52.18,"discounted_cash":36.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx72572060120","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"72572060120","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72572070701","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"72572070701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72572070710","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"72572070710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572074701","type":"CDM"},{"code":"72572074701","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx72572074710","type":"CDM"},{"code":"72572074710","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578000801","type":"CDM"},{"code":"72578000801","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578003601","type":"CDM"},{"code":"72578003601","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZONISAMIDE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578004001","type":"CDM"},{"code":"72578004001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx72578008206","type":"CDM"},{"code":"72578008206","type":"NDC"}],"standard_charges":[{"gross_charge":738.23,"discounted_cash":516.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72578009621","type":"CDM"},{"code":"72578009621","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-ADCD IV SOLN 100 MG/4ML (FOR INFUSION)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx72606001101","type":"CDM"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001101","type":"NDC"}],"standard_charges":[{"gross_charge":5412.96,"discounted_cash":3789.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BEVACIZUMAB-ADCD IV SOLN 400 MG/16ML (FOR INFUSION)","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"Rx72606001201","type":"CDM"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001201","type":"NDC"}],"standard_charges":[{"gross_charge":13285.52,"discounted_cash":9299.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076501","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMSIROLIMUS SOLN FOR IV INFUSION 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72611078001","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"72611078001","type":"NDC"}],"standard_charges":[{"gross_charge":5478.6,"discounted_cash":3835.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TEMSIROLIMUS SOLN FOR IV INFUSION 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72611078502","type":"CDM"},{"code":"J9330","type":"HCPCS"},{"code":"72611078502","type":"NDC"}],"standard_charges":[{"gross_charge":5419.43,"discounted_cash":3793.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72819015205","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"72819015205","type":"NDC"}],"standard_charges":[{"gross_charge":574.9,"discounted_cash":402.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MITOMYCIN FOR IV SOLN 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72819015404","type":"CDM"},{"code":"J9280","type":"HCPCS"},{"code":"72819015404","type":"NDC"}],"standard_charges":[{"gross_charge":3371.77,"discounted_cash":2360.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BACLOFEN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888000901","type":"CDM"},{"code":"72888000901","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006201","type":"CDM"},{"code":"72888006201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BUSPIRONE HCL TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888006301","type":"CDM"},{"code":"72888006301","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888008001","type":"CDM"},{"code":"72888008001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx72888014938","type":"CDM"},{"code":"72888014938","type":"NDC"}],"standard_charges":[{"gross_charge":219.9,"discounted_cash":153.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRAMADOL HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888016230","type":"CDM"},{"code":"72888016230","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":21.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888019201","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"72888019201","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MIRVETUXIMAB SORAVTANSINE-GYNX IV SOLN 100 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx72903085301","type":"CDM"},{"code":"J9063","type":"HCPCS"},{"code":"72903085301","type":"NDC"}],"standard_charges":[{"gross_charge":41840.32,"discounted_cash":29288.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx73070010011","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"gross_charge":684.52,"discounted_cash":479.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"UBLITUXIMAB-XIIY SOLN FOR IV INFUSION 150 MG/6ML","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"Rx73150015006","type":"CDM"},{"code":"J2329","type":"HCPCS"},{"code":"73150015006","type":"NDC"}],"standard_charges":[{"gross_charge":48529.02,"discounted_cash":33970.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx73473030370","type":"CDM"},{"code":"73473030370","type":"NDC"}],"standard_charges":[{"gross_charge":182.07,"discounted_cash":127.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TAFASITAMAB-CXIX FOR IV SOLN 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73535020801","type":"CDM"},{"code":"J9349","type":"HCPCS"},{"code":"73535020801","type":"NDC"}],"standard_charges":[{"gross_charge":10157.98,"discounted_cash":7110.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 10000-32000-42000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73562011001","type":"CDM"},{"code":"73562011001","type":"NDC"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":23.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 20000-63000-84000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73562011201","type":"CDM"},{"code":"73562011201","type":"NDC"}],"standard_charges":[{"gross_charge":77.7,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":1177.5,"discounted_cash":824.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ZINC OXIDE PASTE 40%","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx74300000071","type":"CDM"},{"code":"74300000071","type":"NDC"}],"standard_charges":[{"gross_charge":49.49,"discounted_cash":34.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74312001380","type":"CDM"},{"code":"74312001380","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74312002832","type":"CDM"},{"code":"74312002832","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.37,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.83,"discounted_cash":11.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ERGOCALCIFEROL SOLN 200 MCG/ML (8000 UNIT/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx75834001060","type":"CDM"},{"code":"75834001060","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015801","type":"CDM"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015901","type":"CDM"},{"code":"75834015901","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DECITABINE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834019001","type":"CDM"},{"code":"J0894","type":"HCPCS"},{"code":"75834019001","type":"NDC"}],"standard_charges":[{"gross_charge":1641.32,"discounted_cash":1148.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834022101","type":"CDM"},{"code":"75834022101","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx75907012907","type":"CDM"},{"code":"75907012907","type":"NDC"}],"standard_charges":[{"gross_charge":131.29,"discounted_cash":91.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYCLOPHOSPHAMIDE IV SOLN 1 GM/5ML (200 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx75907019007","type":"CDM"},{"code":"J9073","type":"HCPCS"},{"code":"75907019007","type":"NDC"}],"standard_charges":[{"gross_charge":2314.93,"discounted_cash":1620.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000401","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000401","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000411","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":18.33,"discounted_cash":12.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000901","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000906","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000911","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045012101","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045012101","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":12.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045012111","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045012111","type":"NDC"}],"standard_charges":[{"gross_charge":18.26,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":21818.79,"discounted_cash":15273.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010201","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010201","type":"NDC"}],"standard_charges":[{"gross_charge":12545.8,"discounted_cash":8782.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CARFILZOMIB FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76075010301","type":"CDM"},{"code":"J9047","type":"HCPCS"},{"code":"76075010301","type":"NDC"}],"standard_charges":[{"gross_charge":5266.94,"discounted_cash":3686.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":15.97,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx76204020001","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204030003","type":"CDM"},{"code":"76204030003","type":"NDC"}],"standard_charges":[{"gross_charge":15.42,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204060001","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204080001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":15.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 0.63 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204080011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204080011","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":14.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090001","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":15.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090011","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090011","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":14.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090015","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090015","type":"NDC"}],"standard_charges":[{"gross_charge":19.63,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU 1.25 MG/3ML (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204090025","type":"CDM"},{"code":"J7614","type":"HCPCS"},{"code":"76204090025","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":232.86,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329301105","type":"CDM"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"gross_charge":77.41,"discounted_cash":54.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329301205","type":"CDM"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"gross_charge":85.18,"discounted_cash":59.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329301305","type":"CDM"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":88.61,"discounted_cash":62.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330201","type":"CDM"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":113.97,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":76.38,"discounted_cash":53.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx76329331801","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx76329334001","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":142.95,"discounted_cash":100.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":58.32,"discounted_cash":40.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":510.18,"discounted_cash":357.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":"Rx76329906000","type":"CDM"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333011810","type":"CDM"},{"code":"77333011810","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333011825","type":"CDM"},{"code":"77333011825","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333030810","type":"CDM"},{"code":"77333030810","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333030825","type":"CDM"},{"code":"77333030825","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTASE TAB 3000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333043025","type":"CDM"},{"code":"77333043025","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LACTASE TAB 3000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333043050","type":"CDM"},{"code":"77333043050","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333051610","type":"CDM"},{"code":"77333051610","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333051625","type":"CDM"},{"code":"77333051625","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333071510","type":"CDM"},{"code":"77333071510","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333071525","type":"CDM"},{"code":"77333071525","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081210","type":"CDM"},{"code":"77333081210","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081225","type":"CDM"},{"code":"77333081225","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333082710","type":"CDM"},{"code":"77333082710","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333082725","type":"CDM"},{"code":"77333082725","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083125","type":"CDM"},{"code":"77333083125","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333084410","type":"CDM"},{"code":"77333084410","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333084425","type":"CDM"},{"code":"77333084425","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093810","type":"CDM"},{"code":"77333093810","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093825","type":"CDM"},{"code":"77333093825","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095110","type":"CDM"},{"code":"77333095110","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095125","type":"CDM"},{"code":"77333095125","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CALCIUM GLUCONATE GEL 2.5%","drug_information":{"unit":25.0,"type":"GM"},"code_information":[{"code":"Rx77683006306","type":"CDM"},{"code":"77683006306","type":"NDC"}],"standard_charges":[{"gross_charge":169.8,"discounted_cash":118.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx78112001103","type":"CDM"},{"code":"78112001103","type":"NDC"}],"standard_charges":[{"gross_charge":33.98,"discounted_cash":23.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":33.98,"discounted_cash":23.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011403","type":"CDM"},{"code":"78206011403","type":"NDC"}],"standard_charges":[{"gross_charge":313.37,"discounted_cash":219.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx78206011801","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":70.14,"discounted_cash":49.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016201","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":3091.72,"discounted_cash":2164.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016299","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016299","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":2954.93,"discounted_cash":2068.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN CHEW TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681004900","type":"CDM"},{"code":"80681004900","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"NIACIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681005700","type":"CDM"},{"code":"80681005700","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681007100","type":"CDM"},{"code":"80681007100","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681009700","type":"CDM"},{"code":"80681009700","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681009800","type":"CDM"},{"code":"80681009800","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEDIATRIC MULTIPLE VITAMIN CHEW TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681011600","type":"CDM"},{"code":"80681011600","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681016000","type":"CDM"},{"code":"80681016000","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681016900","type":"CDM"},{"code":"80681016900","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681017000","type":"CDM"},{"code":"80681017000","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx80830169101","type":"CDM"},{"code":"80830169101","type":"NDC"}],"standard_charges":[{"gross_charge":341.38,"discounted_cash":238.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx80830169102","type":"CDM"},{"code":"80830169102","type":"NDC"}],"standard_charges":[{"gross_charge":91.29,"discounted_cash":63.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81033001715","type":"CDM"},{"code":"81033001715","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81033001750","type":"CDM"},{"code":"81033001750","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx81033002501","type":"CDM"},{"code":"81033002501","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx81033002550","type":"CDM"},{"code":"81033002550","type":"NDC"}],"standard_charges":[{"gross_charge":37.78,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033010210","type":"CDM"},{"code":"81033010210","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033010252","type":"CDM"},{"code":"81033010252","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033012005","type":"CDM"},{"code":"81033012005","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033012050","type":"CDM"},{"code":"81033012050","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx81033051215","type":"CDM"},{"code":"81033051215","type":"NDC"}],"standard_charges":[{"gross_charge":18.58,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx81033051250","type":"CDM"},{"code":"81033051250","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061100","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061100","type":"NDC"}],"standard_charges":[{"gross_charge":27.04,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061110","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"},{"gross_charge":24.47,"discounted_cash":17.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061200","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061200","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061210","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061210","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM 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":5.53,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"ISONIAZID TAB 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81665010830","type":"CDM"},{"code":"81665010830","type":"NDC"}],"standard_charges":[{"gross_charge":31.83,"discounted_cash":22.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEMIVIBART IV SOLN 500 MG/4ML (125 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx81960003103","type":"CDM"},{"code":"Q0224","type":"HCPCS"},{"code":"81960003103","type":"NDC"}],"standard_charges":[{"gross_charge":3965.5,"discounted_cash":2775.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82036427401","type":"CDM"},{"code":"82036427401","type":"NDC"}],"standard_charges":[{"gross_charge":254.83,"discounted_cash":178.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050504","type":"CDM"},{"code":"82347050504","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050505","type":"CDM"},{"code":"82347050505","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx82584079201","type":"CDM"},{"code":"82584079201","type":"NDC"}],"standard_charges":[{"gross_charge":208.42,"discounted_cash":145.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx82584079225","type":"CDM"},{"code":"82584079225","type":"NDC"}],"standard_charges":[{"gross_charge":208.44,"discounted_cash":145.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-KETOROLAC INTRAOCULAR SOLN 1-0.3%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx82604060000","type":"CDM"},{"code":"J1097","type":"HCPCS"},{"code":"82604060000","type":"NDC"}],"standard_charges":[{"gross_charge":1474.66,"discounted_cash":1032.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PHENYLEPHRINE-KETOROLAC INTRAOCULAR SOLN 1-0.3%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx82604060004","type":"CDM"},{"code":"J1097","type":"HCPCS"},{"code":"82604060004","type":"NDC"}],"standard_charges":[{"gross_charge":1474.66,"discounted_cash":1032.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82667020001","type":"CDM"},{"code":"82667020001","type":"NDC"}],"standard_charges":[{"gross_charge":117.71,"discounted_cash":82.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMETELSTAT SODIUM FOR IV SOLN 188 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82959011101","type":"CDM"},{"code":"J0870","type":"HCPCS"},{"code":"82959011101","type":"NDC"}],"standard_charges":[{"gross_charge":45469.55,"discounted_cash":31828.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMETELSTAT SODIUM FOR IV SOLN 47 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82959011201","type":"CDM"},{"code":"J0870","type":"HCPCS"},{"code":"82959011201","type":"NDC"}],"standard_charges":[{"gross_charge":11367.42,"discounted_cash":7957.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83257000311","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"83257000311","type":"NDC"}],"standard_charges":[{"gross_charge":9785.58,"discounted_cash":6849.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRASTUZUMAB-DKST FOR IV SOLN 420 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83257000412","type":"CDM"},{"code":"Q5114","type":"HCPCS"},{"code":"83257000412","type":"NDC"}],"standard_charges":[{"gross_charge":6422.31,"discounted_cash":4495.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PEGFILGRASTIM-JMDB SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx83257000541","type":"CDM"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":5557.81,"discounted_cash":3890.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx83634040110","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"83634040110","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx83634040110","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"83634040110","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx83634040141","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"83634040141","type":"NDC"}],"standard_charges":[{"gross_charge":20.19,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx83634040141","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"83634040141","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83634077610","type":"CDM"},{"code":"J1453","type":"HCPCS"},{"code":"83634077610","type":"NDC"}],"standard_charges":[{"gross_charge":146.19,"discounted_cash":102.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx83634077802","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"83634077802","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx83634077841","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"83634077841","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83851010030","type":"CDM"},{"code":"83851010030","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"VITAMIN A CAP 3 MG (10000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx87701040725","type":"CDM"},{"code":"87701040725","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295012836","type":"CDM"},{"code":"96295012836","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION"}]},{"description":"IMP KNEE IB2 CCK TIB ARTICULAT","code_information":[{"code":"Sx00 5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"294411","type":"LOCAL"},{"code":"421540","type":"LOCAL"}],"standard_charges":[{"gross_charge":10262.31,"discounted_cash":7183.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 294411 = Hospital System Supply Identifier | 421540 = 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":"743218","type":"LOCAL"},{"code":"773375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1032.64,"discounted_cash":722.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 743218 = Hospital System Supply Identifier | 773375 = 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":"38896","type":"LOCAL"},{"code":"245960","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38896 = Hospital System Supply Identifier | 245960 = 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":"38900","type":"LOCAL"},{"code":"245971","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38900 = 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":"38899","type":"LOCAL"},{"code":"245970","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38899 = 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":"38897","type":"LOCAL"},{"code":"245961","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38897 = Hospital System Supply Identifier | 245961 = 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":"38894","type":"LOCAL"},{"code":"245958","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38894 = 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":"38893","type":"LOCAL"},{"code":"245957","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38893 = Hospital System Supply Identifier | 245957 = 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":"38892","type":"LOCAL"},{"code":"245956","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38892 = Hospital System Supply Identifier | 245956 = 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":"38895","type":"LOCAL"},{"code":"245959","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38895 = Hospital System Supply Identifier | 245959 = 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":"38890","type":"LOCAL"},{"code":"245954","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38890 = 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":"38889","type":"LOCAL"},{"code":"245953","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38889 = Hospital System Supply Identifier | 245953 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38888","type":"LOCAL"},{"code":"245952","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38888 = Hospital System Supply Identifier | 245952 = 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":"38887","type":"LOCAL"},{"code":"245951","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38887 = 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":"38886","type":"LOCAL"},{"code":"245950","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38886 = 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":"38885","type":"LOCAL"},{"code":"245949","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38885 = Hospital System Supply Identifier | 245949 = 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":"38891","type":"LOCAL"},{"code":"245955","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38891 = Hospital System Supply Identifier | 245955 = 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":"62213","type":"LOCAL"},{"code":"245948","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62213 = 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":"62212","type":"LOCAL"},{"code":"245947","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62212 = 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":"62211","type":"LOCAL"},{"code":"245946","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62211 = 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":"62210","type":"LOCAL"},{"code":"245945","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62210 = 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":"62209","type":"LOCAL"},{"code":"245944","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62209 = Hospital System Supply Identifier | 245944 = 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":"62208","type":"LOCAL"},{"code":"245943","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62208 = Hospital System Supply Identifier | 245943 = 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":"62207","type":"LOCAL"},{"code":"245942","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62207 = 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":"62203","type":"LOCAL"},{"code":"245927","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62203 = 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":"62205","type":"LOCAL"},{"code":"245940","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62205 = Hospital System Supply Identifier | 245940 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62202","type":"LOCAL"},{"code":"245926","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62202 = Hospital System Supply Identifier | 245926 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62201","type":"LOCAL"},{"code":"245923","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62201 = Hospital System Supply Identifier | 245923 = 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":"62200","type":"LOCAL"},{"code":"245922","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62200 = 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":"62199","type":"LOCAL"},{"code":"245920","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62199 = 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":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62214","type":"LOCAL"},{"code":"245969","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62214 = Hospital System Supply Identifier | 245969 = 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":"62206","type":"LOCAL"},{"code":"245941","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.62,"discounted_cash":266.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62206 = Hospital System Supply Identifier | 245941 = Lawson ID"}]},{"description":"DISC - PIN STNMN 2.4MMX60CM","code_information":[{"code":"Sx00-0409-021","type":"CDM"},{"code":"272","type":"RC"},{"code":"384645","type":"LOCAL"},{"code":"417181","type":"LOCAL"}],"standard_charges":[{"gross_charge":391.5,"discounted_cash":274.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384645 = 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":"151398","type":"LOCAL"},{"code":"437117","type":"LOCAL"}],"standard_charges":[{"gross_charge":452.4,"discounted_cash":316.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 151398 = 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":"384646","type":"LOCAL"},{"code":"417182","type":"LOCAL"}],"standard_charges":[{"gross_charge":452.4,"discounted_cash":316.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384646 = 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":"384658","type":"LOCAL"},{"code":"418220","type":"LOCAL"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":548.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384658 = 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":"383807","type":"LOCAL"},{"code":"402333","type":"LOCAL"}],"standard_charges":[{"gross_charge":565.5,"discounted_cash":395.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383807 = 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":"383808","type":"LOCAL"},{"code":"402334","type":"LOCAL"}],"standard_charges":[{"gross_charge":565.5,"discounted_cash":395.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383808 = 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":"36519","type":"LOCAL"},{"code":"106778","type":"LOCAL"}],"standard_charges":[{"gross_charge":63.48,"discounted_cash":44.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36519 = 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":"62204","type":"LOCAL"},{"code":"245931","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 62204 = 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":"38869","type":"LOCAL"},{"code":"245915","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38869 = 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":"38868","type":"LOCAL"},{"code":"245914","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38868 = 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":"38867","type":"LOCAL"},{"code":"245913","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38867 = 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":"38866","type":"LOCAL"},{"code":"245912","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38866 = Hospital System Supply Identifier | 245912 = 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":"38865","type":"LOCAL"},{"code":"245911","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38865 = Hospital System Supply Identifier | 245911 = 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":"38864","type":"LOCAL"},{"code":"245910","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38864 = 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":"38863","type":"LOCAL"},{"code":"245909","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 38863 = 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":"36982","type":"LOCAL"},{"code":"142730","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36982 = Hospital System Supply Identifier | 142730 = 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":"28161","type":"LOCAL"},{"code":"116024","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 28161 = Hospital System Supply Identifier | 116024 = 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":"36573","type":"LOCAL"},{"code":"116023","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36573 = 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":"31360","type":"LOCAL"},{"code":"328029","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 31360 = 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":"68375","type":"LOCAL"},{"code":"206202","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68375 = 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":"46788","type":"LOCAL"},{"code":"206201","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 46788 = 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":"68374","type":"LOCAL"},{"code":"206200","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68374 = 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":"65330","type":"LOCAL"},{"code":"147124","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65330 = 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":"3903","type":"LOCAL"},{"code":"147122","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 3903 = 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":"65136","type":"LOCAL"},{"code":"142731","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65136 = 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":"61895","type":"LOCAL"},{"code":"116020","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 61895 = 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":"28160","type":"LOCAL"},{"code":"116019","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 28160 = 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":"65329","type":"LOCAL"},{"code":"147123","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65329 = Hospital System Supply Identifier | 147123 = 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":"65334","type":"LOCAL"},{"code":"147128","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65334 = Hospital System Supply Identifier | 147128 = 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":"68359","type":"LOCAL"},{"code":"206185","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68359 = 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":"68358","type":"LOCAL"},{"code":"206184","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68358 = Hospital System Supply Identifier | 206184 = 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":"68357","type":"LOCAL"},{"code":"206183","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68357 = Hospital System Supply Identifier | 206183 = 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":"68356","type":"LOCAL"},{"code":"206182","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68356 = Hospital System Supply Identifier | 206182 = 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":"68355","type":"LOCAL"},{"code":"206181","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68355 = Hospital System Supply Identifier | 206181 = 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":"65333","type":"LOCAL"},{"code":"147127","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65333 = Hospital System Supply Identifier | 147127 = 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":"68360","type":"LOCAL"},{"code":"206186","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68360 = Hospital System Supply Identifier | 206186 = 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":"65332","type":"LOCAL"},{"code":"147126","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65332 = 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":"65331","type":"LOCAL"},{"code":"147125","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65331 = 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":"61896","type":"LOCAL"},{"code":"116021","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 61896 = 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":"65335","type":"LOCAL"},{"code":"147129","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65335 = Hospital System Supply Identifier | 147129 = 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":"68361","type":"LOCAL"},{"code":"206187","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68361 = Hospital System Supply Identifier | 206187 = 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":"68370","type":"LOCAL"},{"code":"206196","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68370 = Hospital System Supply Identifier | 206196 = 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":"68371","type":"LOCAL"},{"code":"206197","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68371 = Hospital System Supply Identifier | 206197 = 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":"68369","type":"LOCAL"},{"code":"206195","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68369 = Hospital System Supply Identifier | 206195 = 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":"68373","type":"LOCAL"},{"code":"206199","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68373 = 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":"68372","type":"LOCAL"},{"code":"206198","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68372 = Hospital System Supply Identifier | 206198 = 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":"68368","type":"LOCAL"},{"code":"206194","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68368 = Hospital System Supply Identifier | 206194 = 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":"68365","type":"LOCAL"},{"code":"206191","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68365 = Hospital System Supply Identifier | 206191 = 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":"68366","type":"LOCAL"},{"code":"206192","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68366 = Hospital System Supply Identifier | 206192 = 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":"68367","type":"LOCAL"},{"code":"206193","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68367 = Hospital System Supply Identifier | 206193 = 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":"68364","type":"LOCAL"},{"code":"206190","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68364 = 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":"68363","type":"LOCAL"},{"code":"206189","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68363 = 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":"68362","type":"LOCAL"},{"code":"206188","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68362 = 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":"65336","type":"LOCAL"},{"code":"147130","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 65336 = Hospital System Supply Identifier | 147130 = 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":"2172","type":"LOCAL"},{"code":"339794","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2172 = 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":"2140","type":"LOCAL"},{"code":"339793","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2140 = 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":"2138","type":"LOCAL"},{"code":"339792","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2138 = 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":"2137","type":"LOCAL"},{"code":"339791","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2137 = Hospital System Supply Identifier | 339791 = 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":"2136","type":"LOCAL"},{"code":"339790","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2136 = Hospital System Supply Identifier | 339790 = 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":"2135","type":"LOCAL"},{"code":"339789","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2135 = Hospital System Supply Identifier | 339789 = 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":"2133","type":"LOCAL"},{"code":"339787","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2133 = Hospital System Supply Identifier | 339787 = 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":"2132","type":"LOCAL"},{"code":"339786","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2132 = 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":"2131","type":"LOCAL"},{"code":"339785","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2131 = Hospital System Supply Identifier | 339785 = 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":"2130","type":"LOCAL"},{"code":"339784","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2130 = Hospital System Supply Identifier | 339784 = 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":"2129","type":"LOCAL"},{"code":"339783","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2129 = Hospital System Supply Identifier | 339783 = 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":"2134","type":"LOCAL"},{"code":"339788","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.35,"discounted_cash":246.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2134 = Hospital System Supply Identifier | 339788 = 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":"877608","type":"LOCAL"},{"code":"876277","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877608 = Hospital System Supply Identifier | 876277 = 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":"877606","type":"LOCAL"},{"code":"876275","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877606 = 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":"877607","type":"LOCAL"},{"code":"876276","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877607 = Hospital System Supply Identifier | 876276 = 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":"877611","type":"LOCAL"},{"code":"876280","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877611 = 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":"877609","type":"LOCAL"},{"code":"876278","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877609 = Hospital System Supply Identifier | 876278 = 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":"877610","type":"LOCAL"},{"code":"876279","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877610 = Hospital System Supply Identifier | 876279 = 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":"636096","type":"LOCAL"},{"code":"711671","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 636096 = 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":"636097","type":"LOCAL"},{"code":"711672","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 636097 = 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":"636098","type":"LOCAL"},{"code":"711673","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 636098 = Hospital System Supply Identifier | 711673 = 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":"934131","type":"LOCAL"},{"code":"787027","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934131 = Hospital System Supply Identifier | 787027 = 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":"877612","type":"LOCAL"},{"code":"876281","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877612 = Hospital System Supply Identifier | 876281 = 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":"934135","type":"LOCAL"},{"code":"829511","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934135 = Hospital System Supply Identifier | 829511 = 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":"877613","type":"LOCAL"},{"code":"876282","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877613 = Hospital System Supply Identifier | 876282 = 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":"934133","type":"LOCAL"},{"code":"816524","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934133 = Hospital System Supply Identifier | 816524 = 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":"934132","type":"LOCAL"},{"code":"816523","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934132 = 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":"934134","type":"LOCAL"},{"code":"816522","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934134 = Hospital System Supply Identifier | 816522 = 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":"934137","type":"LOCAL"},{"code":"816521","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934137 = 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":"934136","type":"LOCAL"},{"code":"816525","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934136 = 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":"877614","type":"LOCAL"},{"code":"876283","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877614 = 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":"877615","type":"LOCAL"},{"code":"876284","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877615 = 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":"877616","type":"LOCAL"},{"code":"876285","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877616 = 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":"877617","type":"LOCAL"},{"code":"876286","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877617 = Hospital System Supply Identifier | 876286 = 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":"877621","type":"LOCAL"},{"code":"876290","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877621 = Hospital System Supply Identifier | 876290 = 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":"877622","type":"LOCAL"},{"code":"876291","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877622 = Hospital System Supply Identifier | 876291 = 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":"877620","type":"LOCAL"},{"code":"876289","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877620 = Hospital System Supply Identifier | 876289 = 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":"934138","type":"LOCAL"},{"code":"800288","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934138 = Hospital System Supply Identifier | 800288 = 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":"877618","type":"LOCAL"},{"code":"876287","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877618 = 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":"877619","type":"LOCAL"},{"code":"876288","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877619 = Hospital System Supply Identifier | 876288 = 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":"934139","type":"LOCAL"},{"code":"784755","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934139 = Hospital System Supply Identifier | 784755 = 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":"934140","type":"LOCAL"},{"code":"784756","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934140 = Hospital System Supply Identifier | 784756 = 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":"877623","type":"LOCAL"},{"code":"876292","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877623 = Hospital System Supply Identifier | 876292 = 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":"877624","type":"LOCAL"},{"code":"876293","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877624 = Hospital System Supply Identifier | 876293 = 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":"877625","type":"LOCAL"},{"code":"876294","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877625 = Hospital System Supply Identifier | 876294 = 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":"877626","type":"LOCAL"},{"code":"876295","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877626 = Hospital System Supply Identifier | 876295 = 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":"877628","type":"LOCAL"},{"code":"876297","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877628 = Hospital System Supply Identifier | 876297 = 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":"877627","type":"LOCAL"},{"code":"876296","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877627 = Hospital System Supply Identifier | 876296 = 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":"877629","type":"LOCAL"},{"code":"876298","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877629 = Hospital System Supply Identifier | 876298 = 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":"934144","type":"LOCAL"},{"code":"816517","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934144 = 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":"934143","type":"LOCAL"},{"code":"816519","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934143 = Hospital System Supply Identifier | 816519 = 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":"934141","type":"LOCAL"},{"code":"827838","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934141 = 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":"934142","type":"LOCAL"},{"code":"827839","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934142 = Hospital System Supply Identifier | 827839 = 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":"877630","type":"LOCAL"},{"code":"876299","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877630 = Hospital System Supply Identifier | 876299 = 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":"934148","type":"LOCAL"},{"code":"830987","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934148 = 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":"877631","type":"LOCAL"},{"code":"876300","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877631 = Hospital System Supply Identifier | 876300 = 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":"934147","type":"LOCAL"},{"code":"829509","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934147 = Hospital System Supply Identifier | 829509 = 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":"934145","type":"LOCAL"},{"code":"816518","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934145 = 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":"934146","type":"LOCAL"},{"code":"816520","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934146 = Hospital System Supply Identifier | 816520 = 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":"934149","type":"LOCAL"},{"code":"829510","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934149 = Hospital System Supply Identifier | 829510 = 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":"934151","type":"LOCAL"},{"code":"829586","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934151 = Hospital System Supply Identifier | 829586 = 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":"934150","type":"LOCAL"},{"code":"830988","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934150 = Hospital System Supply Identifier | 830988 = 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":"877632","type":"LOCAL"},{"code":"876301","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877632 = Hospital System Supply Identifier | 876301 = 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":"877633","type":"LOCAL"},{"code":"876302","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877633 = Hospital System Supply Identifier | 876302 = 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":"877634","type":"LOCAL"},{"code":"876303","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877634 = Hospital System Supply Identifier | 876303 = 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":"877638","type":"LOCAL"},{"code":"876307","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877638 = Hospital System Supply Identifier | 876307 = 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":"877637","type":"LOCAL"},{"code":"876306","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877637 = Hospital System Supply Identifier | 876306 = 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":"877636","type":"LOCAL"},{"code":"876305","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877636 = Hospital System Supply Identifier | 876305 = 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":"934153","type":"LOCAL"},{"code":"829588","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934153 = Hospital System Supply Identifier | 829588 = 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":"934152","type":"LOCAL"},{"code":"829587","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934152 = Hospital System Supply Identifier | 829587 = 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":"877635","type":"LOCAL"},{"code":"876304","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877635 = Hospital System Supply Identifier | 876304 = 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":"877641","type":"LOCAL"},{"code":"876310","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877641 = 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":"934154","type":"LOCAL"},{"code":"829589","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934154 = 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":"877639","type":"LOCAL"},{"code":"876308","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877639 = 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":"877640","type":"LOCAL"},{"code":"876309","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877640 = Hospital System Supply Identifier | 876309 = 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":"877642","type":"LOCAL"},{"code":"876311","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877642 = Hospital System Supply Identifier | 876311 = 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":"877643","type":"LOCAL"},{"code":"876312","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877643 = 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":"934155","type":"LOCAL"},{"code":"829590","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934155 = 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":"877644","type":"LOCAL"},{"code":"876313","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877644 = Hospital System Supply Identifier | 876313 = 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":"934156","type":"LOCAL"},{"code":"816526","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934156 = Hospital System Supply Identifier | 816526 = 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":"877645","type":"LOCAL"},{"code":"876314","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877645 = Hospital System Supply Identifier | 876314 = 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":"877646","type":"LOCAL"},{"code":"876315","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877646 = Hospital System Supply Identifier | 876315 = 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":"877647","type":"LOCAL"},{"code":"876316","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877647 = Hospital System Supply Identifier | 876316 = 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":"877648","type":"LOCAL"},{"code":"876317","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877648 = Hospital System Supply Identifier | 876317 = 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":"877649","type":"LOCAL"},{"code":"876318","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877649 = Hospital System Supply Identifier | 876318 = 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":"877651","type":"LOCAL"},{"code":"876320","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877651 = Hospital System Supply Identifier | 876320 = 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":"934157","type":"LOCAL"},{"code":"816516","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934157 = 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":"934158","type":"LOCAL"},{"code":"827837","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934158 = 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":"877650","type":"LOCAL"},{"code":"876319","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877650 = Hospital System Supply Identifier | 876319 = 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":"877652","type":"LOCAL"},{"code":"876321","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877652 = 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":"877653","type":"LOCAL"},{"code":"876322","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877653 = 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":"877658","type":"LOCAL"},{"code":"876327","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877658 = Hospital System Supply Identifier | 876327 = 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":"877656","type":"LOCAL"},{"code":"876325","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877656 = Hospital System Supply Identifier | 876325 = 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":"877657","type":"LOCAL"},{"code":"876326","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877657 = Hospital System Supply Identifier | 876326 = 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":"877654","type":"LOCAL"},{"code":"876323","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877654 = Hospital System Supply Identifier | 876323 = 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":"934159","type":"LOCAL"},{"code":"830989","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934159 = Hospital System Supply Identifier | 830989 = 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":"877655","type":"LOCAL"},{"code":"876324","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877655 = Hospital System Supply Identifier | 876324 = 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":"877664","type":"LOCAL"},{"code":"876333","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877664 = Hospital System Supply Identifier | 876333 = 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":"877663","type":"LOCAL"},{"code":"876332","type":"LOCAL"}],"standard_charges":[{"gross_charge":9309.77,"discounted_cash":6516.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877663 = Hospital System Supply Identifier | 876332 = 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":"877662","type":"LOCAL"},{"code":"876331","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877662 = Hospital System Supply Identifier | 876331 = 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":"877660","type":"LOCAL"},{"code":"876329","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877660 = Hospital System Supply Identifier | 876329 = 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":"877659","type":"LOCAL"},{"code":"876328","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877659 = Hospital System Supply Identifier | 876328 = 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":"877661","type":"LOCAL"},{"code":"876330","type":"LOCAL"}],"standard_charges":[{"gross_charge":6492.26,"discounted_cash":4544.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877661 = Hospital System Supply Identifier | 876330 = 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":"877665","type":"LOCAL"},{"code":"876334","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877665 = 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":"877666","type":"LOCAL"},{"code":"876335","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877666 = 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":"877667","type":"LOCAL"},{"code":"876336","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877667 = Hospital System Supply Identifier | 876336 = 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":"877668","type":"LOCAL"},{"code":"876337","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877668 = Hospital System Supply Identifier | 876337 = 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":"877669","type":"LOCAL"},{"code":"876338","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877669 = Hospital System Supply Identifier | 876338 = 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":"877670","type":"LOCAL"},{"code":"876339","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877670 = 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":"877671","type":"LOCAL"},{"code":"876340","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877671 = 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":"877672","type":"LOCAL"},{"code":"876341","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877672 = 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":"877673","type":"LOCAL"},{"code":"876342","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877673 = 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":"877674","type":"LOCAL"},{"code":"876343","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877674 = Hospital System Supply Identifier | 876343 = 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":"877678","type":"LOCAL"},{"code":"876347","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877678 = 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":"877677","type":"LOCAL"},{"code":"876346","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877677 = Hospital System Supply Identifier | 876346 = 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":"877679","type":"LOCAL"},{"code":"876348","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877679 = Hospital System Supply Identifier | 876348 = 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":"877675","type":"LOCAL"},{"code":"876344","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877675 = 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":"877676","type":"LOCAL"},{"code":"876345","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877676 = 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":"877680","type":"LOCAL"},{"code":"876349","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877680 = Hospital System Supply Identifier | 876349 = 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":"877685","type":"LOCAL"},{"code":"876354","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877685 = Hospital System Supply Identifier | 876354 = 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":"877684","type":"LOCAL"},{"code":"876353","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877684 = Hospital System Supply Identifier | 876353 = 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":"877681","type":"LOCAL"},{"code":"876350","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877681 = 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":"877682","type":"LOCAL"},{"code":"876351","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877682 = 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":"877683","type":"LOCAL"},{"code":"876352","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877683 = Hospital System Supply Identifier | 876352 = 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":"877686","type":"LOCAL"},{"code":"876355","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877686 = 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":"877687","type":"LOCAL"},{"code":"876356","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877687 = 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":"877688","type":"LOCAL"},{"code":"876357","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877688 = Hospital System Supply Identifier | 876357 = 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":"877689","type":"LOCAL"},{"code":"876358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877689 = Hospital System Supply Identifier | 876358 = 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":"877690","type":"LOCAL"},{"code":"876359","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877690 = Hospital System Supply Identifier | 876359 = 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":"877696","type":"LOCAL"},{"code":"876364","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877696 = Hospital System Supply Identifier | 876364 = 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":"877695","type":"LOCAL"},{"code":"876363","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877695 = Hospital System Supply Identifier | 876363 = 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":"877692","type":"LOCAL"},{"code":"876361","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877692 = Hospital System Supply Identifier | 876361 = 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":"877691","type":"LOCAL"},{"code":"876360","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877691 = Hospital System Supply Identifier | 876360 = 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":"877694","type":"LOCAL"},{"code":"876362","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877694 = Hospital System Supply Identifier | 876362 = 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":"877697","type":"LOCAL"},{"code":"876365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3190.0,"discounted_cash":2233.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877697 = 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":"1175891","type":"LOCAL"},{"code":"1082536","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175891 = 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":"1175776","type":"LOCAL"},{"code":"1082496","type":"LOCAL"}],"standard_charges":[{"gross_charge":6976.89,"discounted_cash":4883.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175776 = 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":"877698","type":"LOCAL"},{"code":"876366","type":"LOCAL"}],"standard_charges":[{"gross_charge":6226.0,"discounted_cash":4358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877698 = 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":"877699","type":"LOCAL"},{"code":"876367","type":"LOCAL"}],"standard_charges":[{"gross_charge":6226.0,"discounted_cash":4358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877699 = 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":"877700","type":"LOCAL"},{"code":"876368","type":"LOCAL"}],"standard_charges":[{"gross_charge":6226.0,"discounted_cash":4358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877700 = 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":"877701","type":"LOCAL"},{"code":"876369","type":"LOCAL"}],"standard_charges":[{"gross_charge":6153.97,"discounted_cash":4307.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877701 = 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":"877702","type":"LOCAL"},{"code":"876370","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877702 = 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":"934160","type":"LOCAL"},{"code":"829591","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934160 = 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":"877703","type":"LOCAL"},{"code":"876371","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877703 = 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":"877704","type":"LOCAL"},{"code":"876372","type":"LOCAL"}],"standard_charges":[{"gross_charge":6350.09,"discounted_cash":4445.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877704 = 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":"877705","type":"LOCAL"},{"code":"876373","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877705 = 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":"934161","type":"LOCAL"},{"code":"829592","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934161 = 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":"877706","type":"LOCAL"},{"code":"876374","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877706 = Hospital System Supply Identifier | 876374 = 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":"877708","type":"LOCAL"},{"code":"876376","type":"LOCAL"}],"standard_charges":[{"gross_charge":6296.6,"discounted_cash":4407.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877708 = Hospital System Supply Identifier | 876376 = 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":"877707","type":"LOCAL"},{"code":"876375","type":"LOCAL"}],"standard_charges":[{"gross_charge":6296.6,"discounted_cash":4407.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877707 = Hospital System Supply Identifier | 876375 = 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":"877709","type":"LOCAL"},{"code":"876377","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877709 = 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":"877710","type":"LOCAL"},{"code":"876378","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877710 = 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":"877711","type":"LOCAL"},{"code":"876379","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877711 = 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":"877712","type":"LOCAL"},{"code":"876380","type":"LOCAL"}],"standard_charges":[{"gross_charge":6266.1,"discounted_cash":4386.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877712 = 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":"877713","type":"LOCAL"},{"code":"876381","type":"LOCAL"}],"standard_charges":[{"gross_charge":6266.1,"discounted_cash":4386.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877713 = 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":"877714","type":"LOCAL"},{"code":"876382","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877714 = 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":"877715","type":"LOCAL"},{"code":"876383","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877715 = 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":"877716","type":"LOCAL"},{"code":"876384","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877716 = 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":"934162","type":"LOCAL"},{"code":"830396","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934162 = 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":"877717","type":"LOCAL"},{"code":"876385","type":"LOCAL"}],"standard_charges":[{"gross_charge":6519.28,"discounted_cash":4563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877717 = Hospital System Supply Identifier | 876385 = 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":"934163","type":"LOCAL"},{"code":"784754","type":"LOCAL"}],"standard_charges":[{"gross_charge":6767.5,"discounted_cash":4737.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934163 = Hospital System Supply Identifier | 784754 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 8HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877718","type":"LOCAL"},{"code":"876386","type":"LOCAL"}],"standard_charges":[{"gross_charge":9356.88,"discounted_cash":6549.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877718 = Hospital System Supply Identifier | 876386 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 10HL","code_information":[{"code":"Sx00-0907-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877719","type":"LOCAL"},{"code":"876387","type":"LOCAL"}],"standard_charges":[{"gross_charge":9356.88,"discounted_cash":6549.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877719 = Hospital System Supply Identifier | 876387 = 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":"934164","type":"LOCAL"},{"code":"800287","type":"LOCAL"}],"standard_charges":[{"gross_charge":6266.1,"discounted_cash":4386.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934164 = Hospital System Supply Identifier | 800287 = 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":"934165","type":"LOCAL"},{"code":"824109","type":"LOCAL"}],"standard_charges":[{"gross_charge":9356.88,"discounted_cash":6549.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934165 = 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":"877720","type":"LOCAL"},{"code":"876388","type":"LOCAL"}],"standard_charges":[{"gross_charge":6296.6,"discounted_cash":4407.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877720 = 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":"877721","type":"LOCAL"},{"code":"876389","type":"LOCAL"}],"standard_charges":[{"gross_charge":6432.97,"discounted_cash":4503.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877721 = Hospital System Supply Identifier | 876389 = Lawson ID"}]},{"description":"PLATE 103DX4.5MM 10HL","code_information":[{"code":"Sx00-0907-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877722","type":"LOCAL"},{"code":"876390","type":"LOCAL"}],"standard_charges":[{"gross_charge":9356.88,"discounted_cash":6549.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877722 = 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":"877723","type":"LOCAL"},{"code":"876391","type":"LOCAL"}],"standard_charges":[{"gross_charge":6519.28,"discounted_cash":4563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877723 = 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":"877724","type":"LOCAL"},{"code":"876392","type":"LOCAL"}],"standard_charges":[{"gross_charge":6706.28,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877724 = 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":"877725","type":"LOCAL"},{"code":"876393","type":"LOCAL"}],"standard_charges":[{"gross_charge":6121.29,"discounted_cash":4284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877725 = 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":"877726","type":"LOCAL"},{"code":"876394","type":"LOCAL"}],"standard_charges":[{"gross_charge":6296.6,"discounted_cash":4407.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877726 = Hospital System Supply Identifier | 876394 = 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":"877730","type":"LOCAL"},{"code":"876398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877730 = Hospital System Supply Identifier | 876398 = 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":"877729","type":"LOCAL"},{"code":"876397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877729 = Hospital System Supply Identifier | 876397 = 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":"934166","type":"LOCAL"},{"code":"830394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934166 = 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":"877727","type":"LOCAL"},{"code":"876395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877727 = 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":"877728","type":"LOCAL"},{"code":"876396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877728 = Hospital System Supply Identifier | 876396 = 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":"934167","type":"LOCAL"},{"code":"830395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934167 = Hospital System Supply Identifier | 830395 = 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":"877731","type":"LOCAL"},{"code":"876399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877731 = Hospital System Supply Identifier | 876399 = 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":"877732","type":"LOCAL"},{"code":"876400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877732 = 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":"877733","type":"LOCAL"},{"code":"876401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877733 = 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":"877734","type":"LOCAL"},{"code":"876402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877734 = 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":"877735","type":"LOCAL"},{"code":"876403","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877735 = 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":"877736","type":"LOCAL"},{"code":"876404","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.09,"discounted_cash":1425.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877736 = 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":"1176368","type":"LOCAL"},{"code":"1082505","type":"LOCAL"}],"standard_charges":[{"gross_charge":6625.32,"discounted_cash":4637.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176368 = 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":"877737","type":"LOCAL"},{"code":"876405","type":"LOCAL"}],"standard_charges":[{"gross_charge":6897.16,"discounted_cash":4828.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877737 = 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":"1176370","type":"LOCAL"},{"code":"1082555","type":"LOCAL"}],"standard_charges":[{"gross_charge":6625.32,"discounted_cash":4637.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176370 = 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":"877738","type":"LOCAL"},{"code":"876406","type":"LOCAL"}],"standard_charges":[{"gross_charge":6565.04,"discounted_cash":4595.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877738 = Hospital System Supply Identifier | 876406 = 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":"877739","type":"LOCAL"},{"code":"876407","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877739 = 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":"877740","type":"LOCAL"},{"code":"876408","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877740 = 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":"877741","type":"LOCAL"},{"code":"876409","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877741 = Hospital System Supply Identifier | 876409 = 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":"877742","type":"LOCAL"},{"code":"876410","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877742 = Hospital System Supply Identifier | 876410 = 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":"877743","type":"LOCAL"},{"code":"876411","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877743 = Hospital System Supply Identifier | 876411 = 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":"877745","type":"LOCAL"},{"code":"876413","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877745 = Hospital System Supply Identifier | 876413 = 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":"877744","type":"LOCAL"},{"code":"876412","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877744 = Hospital System Supply Identifier | 876412 = 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":"934168","type":"LOCAL"},{"code":"800290","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934168 = Hospital System Supply Identifier | 800290 = 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":"934169","type":"LOCAL"},{"code":"800289","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934169 = Hospital System Supply Identifier | 800289 = 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":"934170","type":"LOCAL"},{"code":"841869","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934170 = Hospital System Supply Identifier | 841869 = 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":"934172","type":"LOCAL"},{"code":"824112","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934172 = Hospital System Supply Identifier | 824112 = 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":"934171","type":"LOCAL"},{"code":"824113","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934171 = Hospital System Supply Identifier | 824113 = 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":"877746","type":"LOCAL"},{"code":"876414","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877746 = Hospital System Supply Identifier | 876414 = 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":"877747","type":"LOCAL"},{"code":"876415","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877747 = Hospital System Supply Identifier | 876415 = 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":"877748","type":"LOCAL"},{"code":"876416","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877748 = Hospital System Supply Identifier | 876416 = 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":"877753","type":"LOCAL"},{"code":"876421","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877753 = Hospital System Supply Identifier | 876421 = 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":"877752","type":"LOCAL"},{"code":"876420","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877752 = Hospital System Supply Identifier | 876420 = 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":"877749","type":"LOCAL"},{"code":"876417","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877749 = 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":"877750","type":"LOCAL"},{"code":"876418","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877750 = 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":"877751","type":"LOCAL"},{"code":"876419","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877751 = Hospital System Supply Identifier | 876419 = 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":"877754","type":"LOCAL"},{"code":"876422","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877754 = Hospital System Supply Identifier | 876422 = 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":"877755","type":"LOCAL"},{"code":"876423","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877755 = Hospital System Supply Identifier | 876423 = 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":"877756","type":"LOCAL"},{"code":"876424","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877756 = 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":"877757","type":"LOCAL"},{"code":"876425","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877757 = 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":"877758","type":"LOCAL"},{"code":"876426","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877758 = 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":"877759","type":"LOCAL"},{"code":"876427","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877759 = 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":"877760","type":"LOCAL"},{"code":"876428","type":"LOCAL"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877760 = Hospital System Supply Identifier | 876428 = 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":"877765","type":"LOCAL"},{"code":"876433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877765 = Hospital System Supply Identifier | 876433 = 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":"877764","type":"LOCAL"},{"code":"876432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877764 = Hospital System Supply Identifier | 876432 = 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":"877762","type":"LOCAL"},{"code":"876430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877762 = Hospital System Supply Identifier | 876430 = 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":"877761","type":"LOCAL"},{"code":"876429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877761 = Hospital System Supply Identifier | 876429 = 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":"877763","type":"LOCAL"},{"code":"876431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877763 = Hospital System Supply Identifier | 876431 = 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":"934173","type":"LOCAL"},{"code":"841867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934173 = Hospital System Supply Identifier | 841867 = 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":"934174","type":"LOCAL"},{"code":"841868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934174 = Hospital System Supply Identifier | 841868 = 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":"877766","type":"LOCAL"},{"code":"876434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877766 = Hospital System Supply Identifier | 876434 = 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":"877767","type":"LOCAL"},{"code":"876435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877767 = Hospital System Supply Identifier | 876435 = 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":"877768","type":"LOCAL"},{"code":"876436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877768 = Hospital System Supply Identifier | 876436 = 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":"877773","type":"LOCAL"},{"code":"876441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877773 = Hospital System Supply Identifier | 876441 = 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":"877772","type":"LOCAL"},{"code":"876440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877772 = Hospital System Supply Identifier | 876440 = 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":"877769","type":"LOCAL"},{"code":"876437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877769 = 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":"877770","type":"LOCAL"},{"code":"876438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877770 = 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":"877771","type":"LOCAL"},{"code":"876439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877771 = Hospital System Supply Identifier | 876439 = 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":"934175","type":"LOCAL"},{"code":"841870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934175 = 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":"934176","type":"LOCAL"},{"code":"841871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934176 = 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":"877774","type":"LOCAL"},{"code":"876442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877774 = Hospital System Supply Identifier | 876442 = 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":"877775","type":"LOCAL"},{"code":"876443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877775 = Hospital System Supply Identifier | 876443 = 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":"877776","type":"LOCAL"},{"code":"876444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877776 = 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":"877777","type":"LOCAL"},{"code":"876445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877777 = Hospital System Supply Identifier | 876445 = 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":"934178","type":"LOCAL"},{"code":"841873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934178 = Hospital System Supply Identifier | 841873 = 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":"934177","type":"LOCAL"},{"code":"841872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934177 = Hospital System Supply Identifier | 841872 = 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":"877778","type":"LOCAL"},{"code":"876446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877778 = 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":"877779","type":"LOCAL"},{"code":"876447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877779 = 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":"877780","type":"LOCAL"},{"code":"876448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877780 = 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":"877781","type":"LOCAL"},{"code":"876449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877781 = 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":"877782","type":"LOCAL"},{"code":"876450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1146.96,"discounted_cash":802.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877782 = Hospital System Supply Identifier | 876450 = 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":"877786","type":"LOCAL"},{"code":"876454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877786 = Hospital System Supply Identifier | 876454 = 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":"877785","type":"LOCAL"},{"code":"876453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877785 = Hospital System Supply Identifier | 876453 = 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":"877787","type":"LOCAL"},{"code":"876455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877787 = Hospital System Supply Identifier | 876455 = 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":"877783","type":"LOCAL"},{"code":"876451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877783 = 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":"877784","type":"LOCAL"},{"code":"876452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877784 = Hospital System Supply Identifier | 876452 = 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":"877788","type":"LOCAL"},{"code":"876456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877788 = 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":"877789","type":"LOCAL"},{"code":"876457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877789 = Hospital System Supply Identifier | 876457 = 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":"877790","type":"LOCAL"},{"code":"876458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877790 = Hospital System Supply Identifier | 876458 = 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":"877791","type":"LOCAL"},{"code":"876459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877791 = Hospital System Supply Identifier | 876459 = 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":"934179","type":"LOCAL"},{"code":"824111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934179 = 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":"877792","type":"LOCAL"},{"code":"876460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877792 = Hospital System Supply Identifier | 876460 = 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":"877794","type":"LOCAL"},{"code":"876462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877794 = Hospital System Supply Identifier | 876462 = 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":"877793","type":"LOCAL"},{"code":"876461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877793 = Hospital System Supply Identifier | 876461 = 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":"934180","type":"LOCAL"},{"code":"824110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1899.8,"discounted_cash":1329.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934180 = 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":"26955","type":"LOCAL"},{"code":"310986","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 26955 = 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":"743219","type":"LOCAL"},{"code":"773376","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.61,"discounted_cash":437.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 743219 = 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":"877795","type":"LOCAL"},{"code":"876463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877795 = 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":"877796","type":"LOCAL"},{"code":"876464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877796 = 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":"934208","type":"LOCAL"},{"code":"816512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934208 = 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":"877797","type":"LOCAL"},{"code":"876465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877797 = 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":"877798","type":"LOCAL"},{"code":"876466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877798 = 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":"877799","type":"LOCAL"},{"code":"876467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877799 = 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":"877800","type":"LOCAL"},{"code":"876468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877800 = 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":"585491","type":"LOCAL"},{"code":"401794","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585491 = 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":"585492","type":"LOCAL"},{"code":"401795","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585492 = 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":"585493","type":"LOCAL"},{"code":"401796","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585493 = 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":"585494","type":"LOCAL"},{"code":"401797","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585494 = 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":"934209","type":"LOCAL"},{"code":"401798","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934209 = 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":"934210","type":"LOCAL"},{"code":"401799","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.16,"discounted_cash":588.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934210 = 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":"934211","type":"LOCAL"},{"code":"401800","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934211 = Hospital System Supply Identifier | 401800 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2MM","code_information":[{"code":"Sx00-1000-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934212","type":"LOCAL"},{"code":"401801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934212 = 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":"934213","type":"LOCAL"},{"code":"401802","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934213 = Hospital System Supply Identifier | 401802 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3MM","code_information":[{"code":"Sx00-1000-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934214","type":"LOCAL"},{"code":"401803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934214 = 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":"934215","type":"LOCAL"},{"code":"401804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934215 = 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":"934216","type":"LOCAL"},{"code":"401805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934216 = 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":"585486","type":"LOCAL"},{"code":"401787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585486 = 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":"585487","type":"LOCAL"},{"code":"401788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585487 = 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":"585488","type":"LOCAL"},{"code":"401789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585488 = 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":"585489","type":"LOCAL"},{"code":"401790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585489 = 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":"585490","type":"LOCAL"},{"code":"401791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585490 = 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":"934217","type":"LOCAL"},{"code":"401792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934217 = 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":"934218","type":"LOCAL"},{"code":"401793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934218 = 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":"591529","type":"LOCAL"},{"code":"454543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591529 = 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":"591418","type":"LOCAL"},{"code":"449446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591418 = 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":"591599","type":"LOCAL"},{"code":"455417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591599 = 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":"591600","type":"LOCAL"},{"code":"455418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591600 = 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":"591601","type":"LOCAL"},{"code":"455419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591601 = 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":"591602","type":"LOCAL"},{"code":"455420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1810.16,"discounted_cash":1267.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 591602 = 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":"877801","type":"LOCAL"},{"code":"876469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877801 = 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":"877802","type":"LOCAL"},{"code":"876470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877802 = 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":"877803","type":"LOCAL"},{"code":"876471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877803 = 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":"934220","type":"LOCAL"},{"code":"827479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934220 = 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":"877804","type":"LOCAL"},{"code":"876472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877804 = 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":"877805","type":"LOCAL"},{"code":"876473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877805 = 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":"934221","type":"LOCAL"},{"code":"827565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934221 = Hospital System Supply Identifier | 827565 = 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":"934222","type":"LOCAL"},{"code":"827470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934222 = Hospital System Supply Identifier | 827470 = 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":"934223","type":"LOCAL"},{"code":"827469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934223 = Hospital System Supply Identifier | 827469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 4003.5ELAS","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934225","type":"LOCAL"},{"code":"829177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934225 = Hospital System Supply Identifier | 829177 = 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":"934224","type":"LOCAL"},{"code":"829382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934224 = Hospital System Supply Identifier | 829382 = 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":"877806","type":"LOCAL"},{"code":"876474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877806 = 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":"877807","type":"LOCAL"},{"code":"876475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877807 = 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":"1175924","type":"LOCAL"},{"code":"1083545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175924 = 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":"1175811","type":"LOCAL"},{"code":"1083589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175811 = 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":"1176252","type":"LOCAL"},{"code":"1083729","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176252 = 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":"1175859","type":"LOCAL"},{"code":"1083742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175859 = 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":"1175779","type":"LOCAL"},{"code":"1083620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175779 = 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":"1175820","type":"LOCAL"},{"code":"1083558","type":"LOCAL"}],"standard_charges":[{"gross_charge":2757.02,"discounted_cash":1929.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175820 = 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":"1176375","type":"LOCAL"},{"code":"1083628","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176375 = 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":"1176396","type":"LOCAL"},{"code":"1083593","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176396 = Hospital System Supply Identifier | 1083593 = 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":"1176051","type":"LOCAL"},{"code":"1083599","type":"LOCAL"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":677.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176051 = Hospital System Supply Identifier | 1083599 = 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":"1176544","type":"LOCAL"},{"code":"1083559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176544 = 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":"1175810","type":"LOCAL"},{"code":"1083659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175810 = 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":"1176178","type":"LOCAL"},{"code":"1083689","type":"LOCAL"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176178 = 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":"1176554","type":"LOCAL"},{"code":"1083616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176554 = 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":"1176263","type":"LOCAL"},{"code":"1083710","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176263 = 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":"1176377","type":"LOCAL"},{"code":"1083716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176377 = 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":"1175860","type":"LOCAL"},{"code":"1083733","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175860 = 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":"1175796","type":"LOCAL"},{"code":"1083707","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175796 = 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":"1175886","type":"LOCAL"},{"code":"1083736","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175886 = 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":"1175789","type":"LOCAL"},{"code":"1083635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175789 = Hospital System Supply Identifier | 1083635 = 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":"1176497","type":"LOCAL"},{"code":"1083723","type":"LOCAL"}],"standard_charges":[{"gross_charge":2898.49,"discounted_cash":2028.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176497 = Hospital System Supply Identifier | 1083723 = Lawson ID"}]},{"description":"GUIDE WIRE 1.6MMX150SMOOTH","code_information":[{"code":"Sx00-1005-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"934226","type":"LOCAL"},{"code":"827218","type":"LOCAL"}],"standard_charges":[{"gross_charge":212.4,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934226 = Hospital System Supply Identifier | 827218 = 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":"877812","type":"LOCAL"},{"code":"876480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1151.68,"discounted_cash":806.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877812 = Hospital System Supply Identifier | 876480 = 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":"877809","type":"LOCAL"},{"code":"876477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1047.84,"discounted_cash":733.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877809 = 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":"877810","type":"LOCAL"},{"code":"876478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1099.76,"discounted_cash":769.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877810 = 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":"877811","type":"LOCAL"},{"code":"876479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1151.68,"discounted_cash":806.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877811 = Hospital System Supply Identifier | 876479 = 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":"877813","type":"LOCAL"},{"code":"876481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877813 = Hospital System Supply Identifier | 876481 = 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":"877817","type":"LOCAL"},{"code":"876485","type":"LOCAL"}],"standard_charges":[{"gross_charge":2483.42,"discounted_cash":1738.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877817 = 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":"877816","type":"LOCAL"},{"code":"876484","type":"LOCAL"}],"standard_charges":[{"gross_charge":2439.29,"discounted_cash":1707.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877816 = Hospital System Supply Identifier | 876484 = 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":"877818","type":"LOCAL"},{"code":"876486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2483.42,"discounted_cash":1738.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877818 = Hospital System Supply Identifier | 876486 = 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":"877814","type":"LOCAL"},{"code":"876482","type":"LOCAL"}],"standard_charges":[{"gross_charge":2351.03,"discounted_cash":1645.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877814 = Hospital System Supply Identifier | 876482 = 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":"877815","type":"LOCAL"},{"code":"876483","type":"LOCAL"}],"standard_charges":[{"gross_charge":2395.16,"discounted_cash":1676.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877815 = Hospital System Supply Identifier | 876483 = 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":"1176611","type":"LOCAL"},{"code":"1083724","type":"LOCAL"}],"standard_charges":[{"gross_charge":2747.15,"discounted_cash":1923.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176611 = 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":"877819","type":"LOCAL"},{"code":"876487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2569.55,"discounted_cash":1798.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877819 = 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":"877820","type":"LOCAL"},{"code":"876488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1784.16,"discounted_cash":1248.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877820 = 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":"877821","type":"LOCAL"},{"code":"876489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1850.24,"discounted_cash":1295.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877821 = 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":"877823","type":"LOCAL"},{"code":"876490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2584.61,"discounted_cash":1809.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877823 = 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":"877824","type":"LOCAL"},{"code":"876491","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877824 = 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":"877829","type":"LOCAL"},{"code":"876496","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877829 = 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":"877828","type":"LOCAL"},{"code":"876495","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877828 = 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":"877826","type":"LOCAL"},{"code":"876493","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877826 = 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":"877825","type":"LOCAL"},{"code":"876492","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877825 = 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":"877827","type":"LOCAL"},{"code":"876494","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877827 = 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":"877830","type":"LOCAL"},{"code":"876497","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877830 = 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":"877831","type":"LOCAL"},{"code":"876498","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877831 = 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":"877832","type":"LOCAL"},{"code":"876499","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877832 = 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":"877833","type":"LOCAL"},{"code":"876500","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877833 = 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":"877834","type":"LOCAL"},{"code":"876501","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877834 = 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":"877839","type":"LOCAL"},{"code":"876506","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877839 = 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":"877838","type":"LOCAL"},{"code":"876505","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877838 = 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":"877836","type":"LOCAL"},{"code":"876503","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877836 = 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":"877835","type":"LOCAL"},{"code":"876502","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877835 = 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":"877837","type":"LOCAL"},{"code":"876504","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877837 = 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":"877840","type":"LOCAL"},{"code":"876507","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877840 = 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":"877841","type":"LOCAL"},{"code":"876508","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877841 = 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":"877842","type":"LOCAL"},{"code":"876509","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.78,"discounted_cash":183.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877842 = 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":"877843","type":"LOCAL"},{"code":"876510","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877843 = 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":"877847","type":"LOCAL"},{"code":"876514","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877847 = 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":"877848","type":"LOCAL"},{"code":"876515","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877848 = 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":"877846","type":"LOCAL"},{"code":"876513","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877846 = 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":"877845","type":"LOCAL"},{"code":"876512","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877845 = 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":"877844","type":"LOCAL"},{"code":"876511","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877844 = 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":"877849","type":"LOCAL"},{"code":"876516","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877849 = 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":"877850","type":"LOCAL"},{"code":"876517","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877850 = 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":"877851","type":"LOCAL"},{"code":"876518","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877851 = 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":"877852","type":"LOCAL"},{"code":"876519","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877852 = 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":"877853","type":"LOCAL"},{"code":"876520","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877853 = 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":"877854","type":"LOCAL"},{"code":"876521","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877854 = 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":"877859","type":"LOCAL"},{"code":"876526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1370.88,"discounted_cash":959.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877859 = 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":"877858","type":"LOCAL"},{"code":"876525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1307.44,"discounted_cash":915.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877858 = 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":"877857","type":"LOCAL"},{"code":"876524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1307.44,"discounted_cash":915.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877857 = 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":"877856","type":"LOCAL"},{"code":"876523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1255.52,"discounted_cash":878.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877856 = 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":"877855","type":"LOCAL"},{"code":"876522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1203.6,"discounted_cash":842.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877855 = 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":"934227","type":"LOCAL"},{"code":"827489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1255.52,"discounted_cash":878.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934227 = 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":"877860","type":"LOCAL"},{"code":"876527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.43,"discounted_cash":978.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877860 = 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":"877861","type":"LOCAL"},{"code":"876528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1406.92,"discounted_cash":984.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877861 = Hospital System Supply Identifier | 876528 = 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":"877865","type":"LOCAL"},{"code":"876532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1895.67,"discounted_cash":1326.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877865 = Hospital System Supply Identifier | 876532 = 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":"877864","type":"LOCAL"},{"code":"876531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1825.46,"discounted_cash":1277.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877864 = Hospital System Supply Identifier | 876531 = 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":"877866","type":"LOCAL"},{"code":"876533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1895.67,"discounted_cash":1326.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877866 = Hospital System Supply Identifier | 876533 = 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":"877862","type":"LOCAL"},{"code":"876529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1809.82,"discounted_cash":1266.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877862 = 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":"877863","type":"LOCAL"},{"code":"876530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1759.38,"discounted_cash":1231.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877863 = Hospital System Supply Identifier | 876530 = 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":"877867","type":"LOCAL"},{"code":"876534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1961.75,"discounted_cash":1373.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877867 = 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":"877868","type":"LOCAL"},{"code":"876535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2154.98,"discounted_cash":1508.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877868 = Hospital System Supply Identifier | 876535 = 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":"877869","type":"LOCAL"},{"code":"876536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2154.98,"discounted_cash":1508.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877869 = Hospital System Supply Identifier | 876536 = 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":"877870","type":"LOCAL"},{"code":"876537","type":"LOCAL"}],"standard_charges":[{"gross_charge":2227.61,"discounted_cash":1559.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877870 = Hospital System Supply Identifier | 876537 = 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":"877871","type":"LOCAL"},{"code":"876538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2227.61,"discounted_cash":1559.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877871 = 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":"877872","type":"LOCAL"},{"code":"876539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2523.54,"discounted_cash":1766.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877872 = 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":"877873","type":"LOCAL"},{"code":"876540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2740.83,"discounted_cash":1918.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877873 = 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":"877874","type":"LOCAL"},{"code":"876541","type":"LOCAL"}],"standard_charges":[{"gross_charge":3004.82,"discounted_cash":2103.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877874 = 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":"877875","type":"LOCAL"},{"code":"876542","type":"LOCAL"}],"standard_charges":[{"gross_charge":3273.55,"discounted_cash":2291.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877875 = 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":"877877","type":"LOCAL"},{"code":"876544","type":"LOCAL"}],"standard_charges":[{"gross_charge":2073.26,"discounted_cash":1451.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877877 = 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":"877876","type":"LOCAL"},{"code":"876543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1936.97,"discounted_cash":1355.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877876 = Hospital System Supply Identifier | 876543 = 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":"877878","type":"LOCAL"},{"code":"876545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1936.97,"discounted_cash":1355.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877878 = 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":"877879","type":"LOCAL"},{"code":"876546","type":"LOCAL"}],"standard_charges":[{"gross_charge":2073.26,"discounted_cash":1451.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877879 = Hospital System Supply Identifier | 876546 = 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":"877880","type":"LOCAL"},{"code":"876547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2587.74,"discounted_cash":1811.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877880 = Hospital System Supply Identifier | 876547 = 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":"877881","type":"LOCAL"},{"code":"876548","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877881 = 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":"877882","type":"LOCAL"},{"code":"876549","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877882 = 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":"877883","type":"LOCAL"},{"code":"876550","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877883 = 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":"877884","type":"LOCAL"},{"code":"876551","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877884 = 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":"877885","type":"LOCAL"},{"code":"876552","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877885 = Hospital System Supply Identifier | 876552 = 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":"877890","type":"LOCAL"},{"code":"876557","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877890 = Hospital System Supply Identifier | 876557 = 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":"877889","type":"LOCAL"},{"code":"876556","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877889 = Hospital System Supply Identifier | 876556 = 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":"877887","type":"LOCAL"},{"code":"876554","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877887 = Hospital System Supply Identifier | 876554 = 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":"877886","type":"LOCAL"},{"code":"876553","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877886 = Hospital System Supply Identifier | 876553 = 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":"877888","type":"LOCAL"},{"code":"876555","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877888 = Hospital System Supply Identifier | 876555 = 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":"877895","type":"LOCAL"},{"code":"876562","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877895 = 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":"877891","type":"LOCAL"},{"code":"876558","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877891 = 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":"877892","type":"LOCAL"},{"code":"876559","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877892 = Hospital System Supply Identifier | 876559 = 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":"877893","type":"LOCAL"},{"code":"876560","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877893 = Hospital System Supply Identifier | 876560 = 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":"877894","type":"LOCAL"},{"code":"876561","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877894 = Hospital System Supply Identifier | 876561 = 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":"877896","type":"LOCAL"},{"code":"876563","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877896 = Hospital System Supply Identifier | 876563 = 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":"877902","type":"LOCAL"},{"code":"876569","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877902 = 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":"877901","type":"LOCAL"},{"code":"876568","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877901 = Hospital System Supply Identifier | 876568 = 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":"877900","type":"LOCAL"},{"code":"876567","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877900 = Hospital System Supply Identifier | 876567 = 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":"877899","type":"LOCAL"},{"code":"876566","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877899 = Hospital System Supply Identifier | 876566 = 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":"877898","type":"LOCAL"},{"code":"876565","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877898 = Hospital System Supply Identifier | 876565 = 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":"877897","type":"LOCAL"},{"code":"876564","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877897 = Hospital System Supply Identifier | 876564 = 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":"877903","type":"LOCAL"},{"code":"876570","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877903 = 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":"877904","type":"LOCAL"},{"code":"876571","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877904 = 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":"877905","type":"LOCAL"},{"code":"876572","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877905 = 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":"877906","type":"LOCAL"},{"code":"876573","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877906 = 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":"877907","type":"LOCAL"},{"code":"876574","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877907 = 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":"877912","type":"LOCAL"},{"code":"876579","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877912 = Hospital System Supply Identifier | 876579 = 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":"877911","type":"LOCAL"},{"code":"876578","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877911 = Hospital System Supply Identifier | 876578 = 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":"877910","type":"LOCAL"},{"code":"876577","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877910 = Hospital System Supply Identifier | 876577 = 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":"877909","type":"LOCAL"},{"code":"876576","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877909 = Hospital System Supply Identifier | 876576 = 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":"877908","type":"LOCAL"},{"code":"876575","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877908 = Hospital System Supply Identifier | 876575 = 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":"877913","type":"LOCAL"},{"code":"876580","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877913 = 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":"877914","type":"LOCAL"},{"code":"876581","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877914 = 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":"877915","type":"LOCAL"},{"code":"876582","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877915 = 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":"877916","type":"LOCAL"},{"code":"876583","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877916 = 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":"877917","type":"LOCAL"},{"code":"876584","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877917 = 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":"877918","type":"LOCAL"},{"code":"876585","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877918 = Hospital System Supply Identifier | 876585 = 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":"877924","type":"LOCAL"},{"code":"876591","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877924 = Hospital System Supply Identifier | 876591 = 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":"877923","type":"LOCAL"},{"code":"876590","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877923 = Hospital System Supply Identifier | 876590 = 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":"877922","type":"LOCAL"},{"code":"876589","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877922 = Hospital System Supply Identifier | 876589 = 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":"877921","type":"LOCAL"},{"code":"876588","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877921 = Hospital System Supply Identifier | 876588 = 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":"877920","type":"LOCAL"},{"code":"876587","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877920 = Hospital System Supply Identifier | 876587 = 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":"877919","type":"LOCAL"},{"code":"876586","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877919 = Hospital System Supply Identifier | 876586 = 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":"877925","type":"LOCAL"},{"code":"876592","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877925 = 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":"877926","type":"LOCAL"},{"code":"876593","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877926 = 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":"877927","type":"LOCAL"},{"code":"876594","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877927 = 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":"877928","type":"LOCAL"},{"code":"876595","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877928 = 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":"877929","type":"LOCAL"},{"code":"876596","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877929 = 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":"877930","type":"LOCAL"},{"code":"876597","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877930 = Hospital System Supply Identifier | 876597 = 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":"877933","type":"LOCAL"},{"code":"876600","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877933 = Hospital System Supply Identifier | 876600 = 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":"877932","type":"LOCAL"},{"code":"876599","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877932 = Hospital System Supply Identifier | 876599 = 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":"877931","type":"LOCAL"},{"code":"876598","type":"LOCAL"}],"standard_charges":[{"gross_charge":3509.0,"discounted_cash":2456.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877931 = Hospital System Supply Identifier | 876598 = 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":"877934","type":"LOCAL"},{"code":"876601","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877934 = 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":"877935","type":"LOCAL"},{"code":"876602","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877935 = Hospital System Supply Identifier | 876602 = 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":"877936","type":"LOCAL"},{"code":"876603","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877936 = Hospital System Supply Identifier | 876603 = 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":"877937","type":"LOCAL"},{"code":"876604","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877937 = Hospital System Supply Identifier | 876604 = 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":"877938","type":"LOCAL"},{"code":"876605","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877938 = 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":"877939","type":"LOCAL"},{"code":"876606","type":"LOCAL"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2821.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877939 = Hospital System Supply Identifier | 876606 = 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":"877940","type":"LOCAL"},{"code":"876607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877940 = 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":"877941","type":"LOCAL"},{"code":"876608","type":"LOCAL"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":3160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877941 = Hospital System Supply Identifier | 876608 = 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":"877944","type":"LOCAL"},{"code":"876611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4551.12,"discounted_cash":3185.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877944 = Hospital System Supply Identifier | 876611 = 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":"877942","type":"LOCAL"},{"code":"876609","type":"LOCAL"}],"standard_charges":[{"gross_charge":4551.12,"discounted_cash":3185.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877942 = 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":"877943","type":"LOCAL"},{"code":"876610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4551.12,"discounted_cash":3185.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877943 = Hospital System Supply Identifier | 876610 = 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":"877945","type":"LOCAL"},{"code":"876612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4551.12,"discounted_cash":3185.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877945 = 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":"877946","type":"LOCAL"},{"code":"876613","type":"LOCAL"}],"standard_charges":[{"gross_charge":5141.08,"discounted_cash":3598.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877946 = 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":"877947","type":"LOCAL"},{"code":"876614","type":"LOCAL"}],"standard_charges":[{"gross_charge":5141.08,"discounted_cash":3598.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877947 = 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":"877948","type":"LOCAL"},{"code":"876615","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877948 = 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":"877949","type":"LOCAL"},{"code":"876616","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877949 = 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":"877950","type":"LOCAL"},{"code":"876617","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877950 = 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":"877951","type":"LOCAL"},{"code":"876618","type":"LOCAL"}],"standard_charges":[{"gross_charge":3930.08,"discounted_cash":2751.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877951 = Hospital System Supply Identifier | 876618 = 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":"877953","type":"LOCAL"},{"code":"876620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877953 = Hospital System Supply Identifier | 876620 = 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":"877952","type":"LOCAL"},{"code":"876619","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877952 = Hospital System Supply Identifier | 876619 = 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":"877954","type":"LOCAL"},{"code":"876621","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877954 = 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":"877955","type":"LOCAL"},{"code":"876622","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877955 = 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":"877956","type":"LOCAL"},{"code":"876623","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877956 = 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":"877957","type":"LOCAL"},{"code":"876624","type":"LOCAL"}],"standard_charges":[{"gross_charge":5477.92,"discounted_cash":3834.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877957 = 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":"877958","type":"LOCAL"},{"code":"876625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3560.04,"discounted_cash":2492.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877958 = 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":"877959","type":"LOCAL"},{"code":"876626","type":"LOCAL"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877959 = 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":"877960","type":"LOCAL"},{"code":"876627","type":"LOCAL"}],"standard_charges":[{"gross_charge":5080.88,"discounted_cash":3556.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877960 = 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":"877961","type":"LOCAL"},{"code":"876628","type":"LOCAL"}],"standard_charges":[{"gross_charge":5746.56,"discounted_cash":4022.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877961 = 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":"877962","type":"LOCAL"},{"code":"876629","type":"LOCAL"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877962 = Hospital System Supply Identifier | 876629 = 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":"877964","type":"LOCAL"},{"code":"876631","type":"LOCAL"}],"standard_charges":[{"gross_charge":5784.52,"discounted_cash":4049.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877964 = Hospital System Supply Identifier | 876631 = 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":"877963","type":"LOCAL"},{"code":"876630","type":"LOCAL"}],"standard_charges":[{"gross_charge":5723.2,"discounted_cash":4006.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877963 = Hospital System Supply Identifier | 876630 = 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":"877965","type":"LOCAL"},{"code":"876632","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877965 = 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":"877966","type":"LOCAL"},{"code":"876633","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877966 = 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":"877967","type":"LOCAL"},{"code":"876634","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877967 = 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":"877968","type":"LOCAL"},{"code":"876635","type":"LOCAL"}],"standard_charges":[{"gross_charge":5314.4,"discounted_cash":3720.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877968 = 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":"877969","type":"LOCAL"},{"code":"876636","type":"LOCAL"}],"standard_charges":[{"gross_charge":5795.84,"discounted_cash":4057.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877969 = 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":"877970","type":"LOCAL"},{"code":"876637","type":"LOCAL"}],"standard_charges":[{"gross_charge":5795.84,"discounted_cash":4057.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877970 = Hospital System Supply Identifier | 876637 = 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":"877971","type":"LOCAL"},{"code":"876638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6180.72,"discounted_cash":4326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877971 = Hospital System Supply Identifier | 876638 = 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":"877972","type":"LOCAL"},{"code":"876639","type":"LOCAL"}],"standard_charges":[{"gross_charge":6180.72,"discounted_cash":4326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877972 = 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":"877973","type":"LOCAL"},{"code":"876640","type":"LOCAL"}],"standard_charges":[{"gross_charge":6180.72,"discounted_cash":4326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877973 = Hospital System Supply Identifier | 876640 = 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":"877974","type":"LOCAL"},{"code":"876641","type":"LOCAL"}],"standard_charges":[{"gross_charge":5402.0,"discounted_cash":3781.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877974 = 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":"877975","type":"LOCAL"},{"code":"876642","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877975 = 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":"877976","type":"LOCAL"},{"code":"876643","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877976 = 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":"877977","type":"LOCAL"},{"code":"876644","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877977 = 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":"877978","type":"LOCAL"},{"code":"876645","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877978 = 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":"877979","type":"LOCAL"},{"code":"876646","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877979 = Hospital System Supply Identifier | 876646 = 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":"877981","type":"LOCAL"},{"code":"876648","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877981 = Hospital System Supply Identifier | 876648 = 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":"877980","type":"LOCAL"},{"code":"876647","type":"LOCAL"}],"standard_charges":[{"gross_charge":6170.48,"discounted_cash":4319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877980 = Hospital System Supply Identifier | 876647 = 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":"877983","type":"LOCAL"},{"code":"876650","type":"LOCAL"}],"standard_charges":[{"gross_charge":5056.8,"discounted_cash":3539.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877983 = Hospital System Supply Identifier | 876650 = 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":"877984","type":"LOCAL"},{"code":"876651","type":"LOCAL"}],"standard_charges":[{"gross_charge":5716.6,"discounted_cash":4001.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877984 = Hospital System Supply Identifier | 876651 = 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":"877982","type":"LOCAL"},{"code":"876649","type":"LOCAL"}],"standard_charges":[{"gross_charge":4154.0,"discounted_cash":2907.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877982 = Hospital System Supply Identifier | 876649 = 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":"877985","type":"LOCAL"},{"code":"876652","type":"LOCAL"}],"standard_charges":[{"gross_charge":6466.4,"discounted_cash":4526.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877985 = Hospital System Supply Identifier | 876652 = 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":"877987","type":"LOCAL"},{"code":"876654","type":"LOCAL"}],"standard_charges":[{"gross_charge":6685.6,"discounted_cash":4679.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877987 = Hospital System Supply Identifier | 876654 = 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":"877986","type":"LOCAL"},{"code":"876653","type":"LOCAL"}],"standard_charges":[{"gross_charge":6444.48,"discounted_cash":4511.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877986 = Hospital System Supply Identifier | 876653 = 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":"877988","type":"LOCAL"},{"code":"876655","type":"LOCAL"}],"standard_charges":[{"gross_charge":5056.8,"discounted_cash":3539.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877988 = 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":"877989","type":"LOCAL"},{"code":"876656","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877989 = 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":"877990","type":"LOCAL"},{"code":"876657","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877990 = Hospital System Supply Identifier | 876657 = 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":"877991","type":"LOCAL"},{"code":"876658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877991 = Hospital System Supply Identifier | 876658 = 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":"877992","type":"LOCAL"},{"code":"876659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877992 = Hospital System Supply Identifier | 876659 = 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":"877993","type":"LOCAL"},{"code":"876660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877993 = Hospital System Supply Identifier | 876660 = 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":"877994","type":"LOCAL"},{"code":"876661","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877994 = Hospital System Supply Identifier | 876661 = 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":"877995","type":"LOCAL"},{"code":"876662","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877995 = Hospital System Supply Identifier | 876662 = 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":"878000","type":"LOCAL"},{"code":"876667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878000 = Hospital System Supply Identifier | 876667 = 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":"877999","type":"LOCAL"},{"code":"876666","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877999 = Hospital System Supply Identifier | 876666 = 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":"877996","type":"LOCAL"},{"code":"876663","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877996 = 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":"877997","type":"LOCAL"},{"code":"876664","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877997 = 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":"877998","type":"LOCAL"},{"code":"876665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 877998 = Hospital System Supply Identifier | 876665 = 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":"878001","type":"LOCAL"},{"code":"876668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878001 = 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":"878002","type":"LOCAL"},{"code":"876669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878002 = Hospital System Supply Identifier | 876669 = 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":"878003","type":"LOCAL"},{"code":"876670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878003 = Hospital System Supply Identifier | 876670 = 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":"878004","type":"LOCAL"},{"code":"876671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878004 = Hospital System Supply Identifier | 876671 = 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":"878005","type":"LOCAL"},{"code":"876672","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878005 = Hospital System Supply Identifier | 876672 = 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":"878008","type":"LOCAL"},{"code":"876675","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878008 = Hospital System Supply Identifier | 876675 = 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":"878006","type":"LOCAL"},{"code":"876673","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878006 = 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":"878007","type":"LOCAL"},{"code":"876674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878007 = Hospital System Supply Identifier | 876674 = 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":"878009","type":"LOCAL"},{"code":"876676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878009 = 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":"878010","type":"LOCAL"},{"code":"876677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878010 = 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":"878011","type":"LOCAL"},{"code":"876678","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878011 = 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":"878012","type":"LOCAL"},{"code":"876679","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878012 = 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":"878013","type":"LOCAL"},{"code":"876680","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878013 = Hospital System Supply Identifier | 876680 = Lawson ID"}]},{"description":"SCREW CORT 2.7X10MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878014","type":"LOCAL"},{"code":"876681","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878014 = 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":"878015","type":"LOCAL"},{"code":"876682","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878015 = 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":"878016","type":"LOCAL"},{"code":"876683","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878016 = Hospital System Supply Identifier | 876683 = Lawson ID"}]},{"description":"SCREW CORT 2.7X16MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878017","type":"LOCAL"},{"code":"876684","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878017 = Hospital System Supply Identifier | 876684 = Lawson ID"}]},{"description":"SCREW CORT 2.7X18MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878018","type":"LOCAL"},{"code":"876685","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878018 = Hospital System Supply Identifier | 876685 = Lawson ID"}]},{"description":"SCREW CORT 2.7X26MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878022","type":"LOCAL"},{"code":"876689","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878022 = Hospital System Supply Identifier | 876689 = Lawson ID"}]},{"description":"SCREW CORT 2.7X20MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878019","type":"LOCAL"},{"code":"876686","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878019 = 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":"878020","type":"LOCAL"},{"code":"876687","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878020 = 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":"878021","type":"LOCAL"},{"code":"876688","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878021 = Hospital System Supply Identifier | 876688 = Lawson ID"}]},{"description":"SCREW CORT 2.7X28MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878023","type":"LOCAL"},{"code":"876690","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878023 = 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":"878028","type":"LOCAL"},{"code":"876695","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878028 = Hospital System Supply Identifier | 876695 = Lawson ID"}]},{"description":"SCREW CORT 2.7X34MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878026","type":"LOCAL"},{"code":"876693","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878026 = Hospital System Supply Identifier | 876693 = Lawson ID"}]},{"description":"SCREW CORT 2.7X36MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878027","type":"LOCAL"},{"code":"876694","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878027 = Hospital System Supply Identifier | 876694 = Lawson ID"}]},{"description":"SCREW CORT 2.7X32MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878025","type":"LOCAL"},{"code":"876692","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878025 = Hospital System Supply Identifier | 876692 = Lawson ID"}]},{"description":"SCREW CORT 2.7X30MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878024","type":"LOCAL"},{"code":"876691","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878024 = Hospital System Supply Identifier | 876691 = Lawson ID"}]},{"description":"SCREW CORT 2.7X40MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878029","type":"LOCAL"},{"code":"876696","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878029 = 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":"878030","type":"LOCAL"},{"code":"876697","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878030 = 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":"878031","type":"LOCAL"},{"code":"876698","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878031 = 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":"878032","type":"LOCAL"},{"code":"876699","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878032 = 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":"878033","type":"LOCAL"},{"code":"876700","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878033 = 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":"878034","type":"LOCAL"},{"code":"876701","type":"LOCAL"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878034 = 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":"878035","type":"LOCAL"},{"code":"876702","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878035 = Hospital System Supply Identifier | 876702 = 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":"878040","type":"LOCAL"},{"code":"876707","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878040 = Hospital System Supply Identifier | 876707 = 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":"878039","type":"LOCAL"},{"code":"876706","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878039 = Hospital System Supply Identifier | 876706 = 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":"878037","type":"LOCAL"},{"code":"876704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878037 = Hospital System Supply Identifier | 876704 = 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":"878036","type":"LOCAL"},{"code":"876703","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878036 = Hospital System Supply Identifier | 876703 = 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":"878038","type":"LOCAL"},{"code":"876705","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878038 = Hospital System Supply Identifier | 876705 = 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":"878041","type":"LOCAL"},{"code":"876708","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878041 = 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":"878042","type":"LOCAL"},{"code":"876709","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878042 = Hospital System Supply Identifier | 876709 = 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":"878043","type":"LOCAL"},{"code":"876710","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878043 = Hospital System Supply Identifier | 876710 = 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":"878044","type":"LOCAL"},{"code":"876711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878044 = Hospital System Supply Identifier | 876711 = 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":"878045","type":"LOCAL"},{"code":"876712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878045 = Hospital System Supply Identifier | 876712 = 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":"878049","type":"LOCAL"},{"code":"876716","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878049 = 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":"878050","type":"LOCAL"},{"code":"876717","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878050 = Hospital System Supply Identifier | 876717 = 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":"878047","type":"LOCAL"},{"code":"876714","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878047 = Hospital System Supply Identifier | 876714 = 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":"878046","type":"LOCAL"},{"code":"876713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878046 = Hospital System Supply Identifier | 876713 = 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":"878048","type":"LOCAL"},{"code":"876715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878048 = Hospital System Supply Identifier | 876715 = 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":"878051","type":"LOCAL"},{"code":"876718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878051 = 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":"878052","type":"LOCAL"},{"code":"876719","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878052 = 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":"878053","type":"LOCAL"},{"code":"876720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878053 = Hospital System Supply Identifier | 876720 = 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":"878054","type":"LOCAL"},{"code":"876721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878054 = Hospital System Supply Identifier | 876721 = 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":"878055","type":"LOCAL"},{"code":"876722","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878055 = Hospital System Supply Identifier | 876722 = 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":"878056","type":"LOCAL"},{"code":"876723","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878056 = 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":"878057","type":"LOCAL"},{"code":"876724","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878057 = Hospital System Supply Identifier | 876724 = Lawson ID"}]},{"description":"SCREW CORT 3.5X18MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878062","type":"LOCAL"},{"code":"876729","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878062 = Hospital System Supply Identifier | 876729 = Lawson ID"}]},{"description":"SCREW CORT 3.5X10MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878058","type":"LOCAL"},{"code":"876725","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878058 = 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":"878059","type":"LOCAL"},{"code":"876726","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878059 = 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":"878060","type":"LOCAL"},{"code":"876727","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878060 = 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":"878061","type":"LOCAL"},{"code":"876728","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878061 = Hospital System Supply Identifier | 876728 = Lawson ID"}]},{"description":"SCREW CORT 3.5X24MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878065","type":"LOCAL"},{"code":"876732","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878065 = Hospital System Supply Identifier | 876732 = Lawson ID"}]},{"description":"SCREW CORT 3.5X26MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878066","type":"LOCAL"},{"code":"876733","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878066 = Hospital System Supply Identifier | 876733 = Lawson ID"}]},{"description":"SCREW CORT 3.5X20MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878063","type":"LOCAL"},{"code":"876730","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878063 = 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":"878064","type":"LOCAL"},{"code":"876731","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878064 = Hospital System Supply Identifier | 876731 = Lawson ID"}]},{"description":"SCREW CORT 3.5X28MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878067","type":"LOCAL"},{"code":"876734","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878067 = Hospital System Supply Identifier | 876734 = Lawson ID"}]},{"description":"SCREW CORT 3.5X38MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878072","type":"LOCAL"},{"code":"876739","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878072 = Hospital System Supply Identifier | 876739 = Lawson ID"}]},{"description":"SCREW CORT 3.5X34MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878070","type":"LOCAL"},{"code":"876737","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878070 = 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":"878071","type":"LOCAL"},{"code":"876738","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878071 = Hospital System Supply Identifier | 876738 = Lawson ID"}]},{"description":"SCREW CORT 3.5X32MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878069","type":"LOCAL"},{"code":"876736","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878069 = Hospital System Supply Identifier | 876736 = Lawson ID"}]},{"description":"SCREW CORT 3.5X30MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878068","type":"LOCAL"},{"code":"876735","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878068 = Hospital System Supply Identifier | 876735 = Lawson ID"}]},{"description":"SCREW CORT 3.5X40MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878073","type":"LOCAL"},{"code":"876740","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878073 = Hospital System Supply Identifier | 876740 = Lawson ID"}]},{"description":"SCREW CORT 3.5X44MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878074","type":"LOCAL"},{"code":"876741","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878074 = 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":"878075","type":"LOCAL"},{"code":"876742","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878075 = Hospital System Supply Identifier | 876742 = Lawson ID"}]},{"description":"SCREW CORT 3.5X52MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878076","type":"LOCAL"},{"code":"876743","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878076 = 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":"878077","type":"LOCAL"},{"code":"876744","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878077 = 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":"878078","type":"LOCAL"},{"code":"876745","type":"LOCAL"}],"standard_charges":[{"gross_charge":852.6,"discounted_cash":596.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878078 = 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":"650259","type":"LOCAL"},{"code":"723730","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.13,"discounted_cash":250.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650259 = 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":"650261","type":"LOCAL"},{"code":"723732","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.91,"discounted_cash":247.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650261 = 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":"650262","type":"LOCAL"},{"code":"723733","type":"LOCAL"}],"standard_charges":[{"gross_charge":352.91,"discounted_cash":247.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650262 = 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":"650263","type":"LOCAL"},{"code":"723734","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.29,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650263 = 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":"650264","type":"LOCAL"},{"code":"723735","type":"LOCAL"}],"standard_charges":[{"gross_charge":328.29,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650264 = 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":"1176175","type":"LOCAL"},{"code":"1083608","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176175 = 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":"1176416","type":"LOCAL"},{"code":"1083538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176416 = 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":"1176137","type":"LOCAL"},{"code":"1083690","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176137 = 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":"610180","type":"LOCAL"},{"code":"593216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.39,"discounted_cash":1731.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 610180 = 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":"878079","type":"LOCAL"},{"code":"876746","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.39,"discounted_cash":1731.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878079 = 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":"610179","type":"LOCAL"},{"code":"593215","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.39,"discounted_cash":1731.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 610179 = 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":"878080","type":"LOCAL"},{"code":"876747","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.39,"discounted_cash":1731.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878080 = 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":"586047","type":"LOCAL"},{"code":"410072","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586047 = Hospital System Supply Identifier | 410072 = 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":"586048","type":"LOCAL"},{"code":"410073","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586048 = 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":"586049","type":"LOCAL"},{"code":"410074","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586049 = 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":"887544","type":"LOCAL"},{"code":"410075","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 887544 = Hospital System Supply Identifier | 410075 = 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":"610182","type":"LOCAL"},{"code":"593218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 610182 = Hospital System Supply Identifier | 593218 = 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":"610181","type":"LOCAL"},{"code":"593217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 610181 = Hospital System Supply Identifier | 593217 = 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":"610183","type":"LOCAL"},{"code":"593219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 610183 = Hospital System Supply Identifier | 593219 = 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":"878081","type":"LOCAL"},{"code":"876748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878081 = Hospital System Supply Identifier | 876748 = 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":"878082","type":"LOCAL"},{"code":"876749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878082 = 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":"878083","type":"LOCAL"},{"code":"876750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1338.11,"discounted_cash":936.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878083 = 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":"934231","type":"LOCAL"},{"code":"418940","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934231 = 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":"1175909","type":"LOCAL"},{"code":"1083673","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175909 = 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":"934232","type":"LOCAL"},{"code":"399815","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934232 = 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":"934233","type":"LOCAL"},{"code":"418942","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934233 = 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":"934234","type":"LOCAL"},{"code":"399817","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934234 = 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":"934235","type":"LOCAL"},{"code":"418944","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934235 = 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":"1176267","type":"LOCAL"},{"code":"1083629","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176267 = 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":"1176059","type":"LOCAL"},{"code":"1083563","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176059 = 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":"1176534","type":"LOCAL"},{"code":"1083682","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176534 = 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":"1175910","type":"LOCAL"},{"code":"1083676","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175910 = 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":"1176684","type":"LOCAL"},{"code":"1083560","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176684 = 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":"1176395","type":"LOCAL"},{"code":"1083601","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176395 = 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":"1176304","type":"LOCAL"},{"code":"1083646","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176304 = 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":"1175928","type":"LOCAL"},{"code":"1083652","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175928 = 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":"1176181","type":"LOCAL"},{"code":"1083606","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176181 = 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":"1176660","type":"LOCAL"},{"code":"1083678","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176660 = 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":"1176180","type":"LOCAL"},{"code":"1083567","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176180 = 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":"1176686","type":"LOCAL"},{"code":"1083541","type":"LOCAL"}],"standard_charges":[{"gross_charge":248.52,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176686 = 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":"934236","type":"LOCAL"},{"code":"405712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934236 = 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":"934237","type":"LOCAL"},{"code":"424925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934237 = 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":"934238","type":"LOCAL"},{"code":"405713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934238 = 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":"878084","type":"LOCAL"},{"code":"876751","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878084 = 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":"934239","type":"LOCAL"},{"code":"405714","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934239 = Hospital System Supply Identifier | 405714 = 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":"934240","type":"LOCAL"},{"code":"405715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934240 = 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":"934242","type":"LOCAL"},{"code":"410076","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934242 = Hospital System Supply Identifier | 410076 = 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":"934243","type":"LOCAL"},{"code":"410077","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934243 = Hospital System Supply Identifier | 410077 = 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":"934244","type":"LOCAL"},{"code":"410078","type":"LOCAL"}],"standard_charges":[{"gross_charge":2036.93,"discounted_cash":1425.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934244 = 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":"878085","type":"LOCAL"},{"code":"876752","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878085 = 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":"878086","type":"LOCAL"},{"code":"876753","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878086 = 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":"934245","type":"LOCAL"},{"code":"824274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934245 = 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":"934246","type":"LOCAL"},{"code":"824273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934246 = 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":"934247","type":"LOCAL"},{"code":"824272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934247 = 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":"878087","type":"LOCAL"},{"code":"876754","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878087 = 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":"934249","type":"LOCAL"},{"code":"827490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934249 = 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":"592173","type":"LOCAL"},{"code":"461780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 592173 = Hospital System Supply Identifier | 461780 = 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":"603745","type":"LOCAL"},{"code":"536297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 603745 = 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":"592174","type":"LOCAL"},{"code":"461781","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 592174 = 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":"592175","type":"LOCAL"},{"code":"461782","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 592175 = 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":"934250","type":"LOCAL"},{"code":"823995","type":"LOCAL"}],"standard_charges":[{"gross_charge":1138.48,"discounted_cash":796.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934250 = 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":"878088","type":"LOCAL"},{"code":"876755","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878088 = Hospital System Supply Identifier | 876755 = 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":"878090","type":"LOCAL"},{"code":"876757","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878090 = 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":"878091","type":"LOCAL"},{"code":"876758","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878091 = Hospital System Supply Identifier | 876758 = 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":"878089","type":"LOCAL"},{"code":"876756","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878089 = Hospital System Supply Identifier | 876756 = 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":"878092","type":"LOCAL"},{"code":"876759","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878092 = 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":"878093","type":"LOCAL"},{"code":"876760","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878093 = 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":"878094","type":"LOCAL"},{"code":"876761","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878094 = Hospital System Supply Identifier | 876761 = 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":"878095","type":"LOCAL"},{"code":"876762","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878095 = Hospital System Supply Identifier | 876762 = 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":"878096","type":"LOCAL"},{"code":"876763","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878096 = 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":"878097","type":"LOCAL"},{"code":"876764","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878097 = Hospital System Supply Identifier | 876764 = 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":"878098","type":"LOCAL"},{"code":"876765","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878098 = 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":"878099","type":"LOCAL"},{"code":"876766","type":"LOCAL"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878099 = 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":"878100","type":"LOCAL"},{"code":"876767","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878100 = 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":"878101","type":"LOCAL"},{"code":"876768","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878101 = Hospital System Supply Identifier | 876768 = Lawson ID"}]},{"description":"O-PLATE TI 24MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878103","type":"LOCAL"},{"code":"876770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878103 = Hospital System Supply Identifier | 876770 = Lawson ID"}]},{"description":"O-PLATE TI 20MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878102","type":"LOCAL"},{"code":"876769","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878102 = Hospital System Supply Identifier | 876769 = Lawson ID"}]},{"description":"I-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878104","type":"LOCAL"},{"code":"876771","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878104 = 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":"878105","type":"LOCAL"},{"code":"876772","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878105 = 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":"878106","type":"LOCAL"},{"code":"876773","type":"LOCAL"}],"standard_charges":[{"gross_charge":2611.2,"discounted_cash":1827.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878106 = 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":"878107","type":"LOCAL"},{"code":"876774","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878107 = 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":"878108","type":"LOCAL"},{"code":"876775","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878108 = 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":"878109","type":"LOCAL"},{"code":"876776","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878109 = 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":"878110","type":"LOCAL"},{"code":"876777","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878110 = 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":"878111","type":"LOCAL"},{"code":"876778","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878111 = 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":"878112","type":"LOCAL"},{"code":"876779","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878112 = 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":"878113","type":"LOCAL"},{"code":"876780","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878113 = 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":"878114","type":"LOCAL"},{"code":"876781","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878114 = 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":"878115","type":"LOCAL"},{"code":"876782","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878115 = 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":"878116","type":"LOCAL"},{"code":"876783","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878116 = 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":"878117","type":"LOCAL"},{"code":"876784","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878117 = 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":"878118","type":"LOCAL"},{"code":"876785","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878118 = 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":"878119","type":"LOCAL"},{"code":"876786","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878119 = 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":"878120","type":"LOCAL"},{"code":"876787","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878120 = 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":"878121","type":"LOCAL"},{"code":"876788","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878121 = 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":"878122","type":"LOCAL"},{"code":"876789","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878122 = 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":"878123","type":"LOCAL"},{"code":"876790","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878123 = 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":"878124","type":"LOCAL"},{"code":"876791","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878124 = 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":"878125","type":"LOCAL"},{"code":"876792","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878125 = 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":"878126","type":"LOCAL"},{"code":"876793","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878126 = 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":"878127","type":"LOCAL"},{"code":"876794","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878127 = 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":"878128","type":"LOCAL"},{"code":"876795","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878128 = 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":"878129","type":"LOCAL"},{"code":"876796","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878129 = 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":"878130","type":"LOCAL"},{"code":"876797","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878130 = 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":"878131","type":"LOCAL"},{"code":"876798","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878131 = 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":"878132","type":"LOCAL"},{"code":"876799","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878132 = 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":"878133","type":"LOCAL"},{"code":"876800","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878133 = 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":"878134","type":"LOCAL"},{"code":"876801","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878134 = 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":"878135","type":"LOCAL"},{"code":"876802","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878135 = 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":"878136","type":"LOCAL"},{"code":"876803","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878136 = 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":"878137","type":"LOCAL"},{"code":"876804","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878137 = 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":"878138","type":"LOCAL"},{"code":"876805","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878138 = 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":"878139","type":"LOCAL"},{"code":"876806","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878139 = 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":"878140","type":"LOCAL"},{"code":"876807","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878140 = 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":"878141","type":"LOCAL"},{"code":"876808","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878141 = 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":"878142","type":"LOCAL"},{"code":"876809","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878142 = 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":"878143","type":"LOCAL"},{"code":"876810","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878143 = 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":"878144","type":"LOCAL"},{"code":"876811","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878144 = 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":"878145","type":"LOCAL"},{"code":"876812","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878145 = 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":"878146","type":"LOCAL"},{"code":"876813","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878146 = 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":"878147","type":"LOCAL"},{"code":"876814","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878147 = 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":"878148","type":"LOCAL"},{"code":"876815","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878148 = 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":"878149","type":"LOCAL"},{"code":"876816","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878149 = 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":"878150","type":"LOCAL"},{"code":"876817","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878150 = 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":"878151","type":"LOCAL"},{"code":"876818","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878151 = 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":"878152","type":"LOCAL"},{"code":"876819","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878152 = 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":"878153","type":"LOCAL"},{"code":"876820","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878153 = 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":"878154","type":"LOCAL"},{"code":"876821","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878154 = 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":"878155","type":"LOCAL"},{"code":"876822","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878155 = 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":"878156","type":"LOCAL"},{"code":"876823","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878156 = 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":"878157","type":"LOCAL"},{"code":"876824","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878157 = 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":"878158","type":"LOCAL"},{"code":"876825","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878158 = 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":"878159","type":"LOCAL"},{"code":"876826","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878159 = 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":"878160","type":"LOCAL"},{"code":"876827","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878160 = 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":"878161","type":"LOCAL"},{"code":"876828","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878161 = 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":"878162","type":"LOCAL"},{"code":"876829","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878162 = 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":"878163","type":"LOCAL"},{"code":"876830","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878163 = 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":"878164","type":"LOCAL"},{"code":"876831","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878164 = 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":"878165","type":"LOCAL"},{"code":"876832","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878165 = 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":"878166","type":"LOCAL"},{"code":"876833","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878166 = 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":"878167","type":"LOCAL"},{"code":"876834","type":"LOCAL"}],"standard_charges":[{"gross_charge":848.25,"discounted_cash":593.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878167 = 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":"360643","type":"LOCAL"},{"code":"144792","type":"LOCAL"}],"standard_charges":[{"gross_charge":694.26,"discounted_cash":485.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 360643 = 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":"360644","type":"LOCAL"},{"code":"144793","type":"LOCAL"}],"standard_charges":[{"gross_charge":694.26,"discounted_cash":485.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 360644 = 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":"360645","type":"LOCAL"},{"code":"144794","type":"LOCAL"}],"standard_charges":[{"gross_charge":694.26,"discounted_cash":485.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 360645 = 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":"360673","type":"LOCAL"},{"code":"232039","type":"LOCAL"}],"standard_charges":[{"gross_charge":694.26,"discounted_cash":485.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 360673 = 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":"650090","type":"LOCAL"},{"code":"723561","type":"LOCAL"}],"standard_charges":[{"gross_charge":590.9,"discounted_cash":413.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650090 = 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":"646764","type":"LOCAL"},{"code":"310249","type":"LOCAL"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 646764 = 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":"743220","type":"LOCAL"},{"code":"773377","type":"LOCAL"}],"standard_charges":[{"gross_charge":641.66,"discounted_cash":449.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 743220 = 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":"650222","type":"LOCAL"},{"code":"723693","type":"LOCAL"}],"standard_charges":[{"gross_charge":433.17,"discounted_cash":303.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 650222 = 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":"934254","type":"LOCAL"},{"code":"410079","type":"LOCAL"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934254 = 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":"934252","type":"LOCAL"},{"code":"414027","type":"LOCAL"}],"standard_charges":[{"gross_charge":565.5,"discounted_cash":395.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934252 = 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":"934253","type":"LOCAL"},{"code":"414028","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934253 = 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":"934255","type":"LOCAL"},{"code":"414029","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.75,"discounted_cash":441.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934255 = 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":"934256","type":"LOCAL"},{"code":"414030","type":"LOCAL"}],"standard_charges":[{"gross_charge":652.5,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934256 = 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":"934257","type":"LOCAL"},{"code":"414031","type":"LOCAL"}],"standard_charges":[{"gross_charge":674.25,"discounted_cash":471.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934257 = Hospital System Supply Identifier | 414031 = 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":"934260","type":"LOCAL"},{"code":"414034","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.5,"discounted_cash":918.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934260 = Hospital System Supply Identifier | 414034 = 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":"934259","type":"LOCAL"},{"code":"414033","type":"LOCAL"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934259 = Hospital System Supply Identifier | 414033 = 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":"934258","type":"LOCAL"},{"code":"414032","type":"LOCAL"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934258 = Hospital System Supply Identifier | 414032 = 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":"934261","type":"LOCAL"},{"code":"414035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1406.25,"discounted_cash":984.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934261 = 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":"586789","type":"LOCAL"},{"code":"414193","type":"LOCAL"}],"standard_charges":[{"gross_charge":8531.24,"discounted_cash":5971.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586789 = 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":"934262","type":"LOCAL"},{"code":"414194","type":"LOCAL"}],"standard_charges":[{"gross_charge":8531.24,"discounted_cash":5971.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934262 = Hospital System Supply Identifier | 414194 = 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":"1176685","type":"LOCAL"},{"code":"1083572","type":"LOCAL"}],"standard_charges":[{"gross_charge":10250.49,"discounted_cash":7175.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176685 = Hospital System Supply Identifier | 1083572 = 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":"934263","type":"LOCAL"},{"code":"410080","type":"LOCAL"}],"standard_charges":[{"gross_charge":8546.76,"discounted_cash":5982.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934263 = Hospital System Supply Identifier | 410080 = 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":"934264","type":"LOCAL"},{"code":"414036","type":"LOCAL"}],"standard_charges":[{"gross_charge":8739.17,"discounted_cash":6117.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934264 = Hospital System Supply Identifier | 414036 = 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":"934265","type":"LOCAL"},{"code":"414037","type":"LOCAL"}],"standard_charges":[{"gross_charge":8931.58,"discounted_cash":6252.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934265 = 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":"934266","type":"LOCAL"},{"code":"414038","type":"LOCAL"}],"standard_charges":[{"gross_charge":10250.49,"discounted_cash":7175.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934266 = Hospital System Supply Identifier | 414038 = 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":"934267","type":"LOCAL"},{"code":"410082","type":"LOCAL"}],"standard_charges":[{"gross_charge":8531.24,"discounted_cash":5971.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934267 = Hospital System Supply Identifier | 410082 = 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":"586050","type":"LOCAL"},{"code":"410081","type":"LOCAL"}],"standard_charges":[{"gross_charge":8531.24,"discounted_cash":5971.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586050 = Hospital System Supply Identifier | 410081 = 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":"1175887","type":"LOCAL"},{"code":"1083743","type":"LOCAL"}],"standard_charges":[{"gross_charge":10250.49,"discounted_cash":7175.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175887 = 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":"934268","type":"LOCAL"},{"code":"414040","type":"LOCAL"}],"standard_charges":[{"gross_charge":8546.76,"discounted_cash":5982.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934268 = 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":"934269","type":"LOCAL"},{"code":"414041","type":"LOCAL"}],"standard_charges":[{"gross_charge":8739.17,"discounted_cash":6117.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934269 = 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":"934270","type":"LOCAL"},{"code":"414042","type":"LOCAL"}],"standard_charges":[{"gross_charge":8931.58,"discounted_cash":6252.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934270 = 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":"934271","type":"LOCAL"},{"code":"414043","type":"LOCAL"}],"standard_charges":[{"gross_charge":10250.49,"discounted_cash":7175.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934271 = 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":"934276","type":"LOCAL"},{"code":"414048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8024.37,"discounted_cash":5617.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934276 = Hospital System Supply Identifier | 414048 = 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":"934273","type":"LOCAL"},{"code":"414046","type":"LOCAL"}],"standard_charges":[{"gross_charge":6246.54,"discounted_cash":4372.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934273 = Hospital System Supply Identifier | 414046 = 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":"934275","type":"LOCAL"},{"code":"414047","type":"LOCAL"}],"standard_charges":[{"gross_charge":7773.61,"discounted_cash":5441.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934275 = Hospital System Supply Identifier | 414047 = 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":"934274","type":"LOCAL"},{"code":"410083","type":"LOCAL"}],"standard_charges":[{"gross_charge":6728.28,"discounted_cash":4709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934274 = Hospital System Supply Identifier | 410083 = 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":"934272","type":"LOCAL"},{"code":"414045","type":"LOCAL"}],"standard_charges":[{"gross_charge":6207.94,"discounted_cash":4345.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934272 = Hospital System Supply Identifier | 414045 = 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":"934278","type":"LOCAL"},{"code":"414049","type":"LOCAL"}],"standard_charges":[{"gross_charge":431.95,"discounted_cash":302.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934278 = 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":"934279","type":"LOCAL"},{"code":"414050","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.57,"discounted_cash":315.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934279 = 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":"934280","type":"LOCAL"},{"code":"414051","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.57,"discounted_cash":315.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934280 = 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":"934281","type":"LOCAL"},{"code":"414052","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.19,"discounted_cash":328.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934281 = 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":"934282","type":"LOCAL"},{"code":"414053","type":"LOCAL"}],"standard_charges":[{"gross_charge":469.19,"discounted_cash":328.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934282 = 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":"934283","type":"LOCAL"},{"code":"414054","type":"LOCAL"}],"standard_charges":[{"gross_charge":534.91,"discounted_cash":374.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934283 = Hospital System Supply Identifier | 414054 = 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":"934285","type":"LOCAL"},{"code":"414056","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934285 = Hospital System Supply Identifier | 414056 = 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":"934284","type":"LOCAL"},{"code":"414055","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934284 = Hospital System Supply Identifier | 414055 = 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":"934286","type":"LOCAL"},{"code":"414057","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934286 = Hospital System Supply Identifier | 414057 = 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":"934287","type":"LOCAL"},{"code":"402528","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934287 = Hospital System Supply Identifier | 402528 = 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":"934288","type":"LOCAL"},{"code":"402529","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934288 = Hospital System Supply Identifier | 402529 = 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":"934290","type":"LOCAL"},{"code":"399820","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934290 = Hospital System Supply Identifier | 399820 = 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":"934291","type":"LOCAL"},{"code":"399821","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934291 = 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":"934292","type":"LOCAL"},{"code":"399822","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934292 = Hospital System Supply Identifier | 399822 = 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":"934293","type":"LOCAL"},{"code":"399823","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934293 = Hospital System Supply Identifier | 399823 = 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":"934294","type":"LOCAL"},{"code":"399824","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934294 = Hospital System Supply Identifier | 399824 = 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":"934298","type":"LOCAL"},{"code":"399828","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934298 = Hospital System Supply Identifier | 399828 = 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":"934297","type":"LOCAL"},{"code":"399827","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934297 = Hospital System Supply Identifier | 399827 = 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":"934299","type":"LOCAL"},{"code":"431449","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934299 = Hospital System Supply Identifier | 431449 = 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":"934295","type":"LOCAL"},{"code":"399825","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934295 = Hospital System Supply Identifier | 399825 = 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":"934296","type":"LOCAL"},{"code":"399826","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934296 = Hospital System Supply Identifier | 399826 = 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":"585334","type":"LOCAL"},{"code":"399829","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585334 = 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":"934300","type":"LOCAL"},{"code":"414058","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934300 = 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":"934301","type":"LOCAL"},{"code":"414059","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934301 = 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":"934302","type":"LOCAL"},{"code":"414060","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934302 = 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":"934303","type":"LOCAL"},{"code":"414061","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934303 = Hospital System Supply Identifier | 414061 = 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":"934308","type":"LOCAL"},{"code":"414066","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934308 = Hospital System Supply Identifier | 414066 = 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":"934304","type":"LOCAL"},{"code":"414062","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934304 = 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":"934305","type":"LOCAL"},{"code":"414063","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934305 = Hospital System Supply Identifier | 414063 = 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":"934306","type":"LOCAL"},{"code":"414064","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934306 = 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":"934307","type":"LOCAL"},{"code":"414065","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934307 = Hospital System Supply Identifier | 414065 = 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":"934310","type":"LOCAL"},{"code":"414068","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934310 = Hospital System Supply Identifier | 414068 = 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":"934309","type":"LOCAL"},{"code":"414067","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934309 = Hospital System Supply Identifier | 414067 = 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":"934311","type":"LOCAL"},{"code":"414069","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934311 = 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":"934313","type":"LOCAL"},{"code":"399830","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934313 = 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":"585335","type":"LOCAL"},{"code":"399831","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585335 = 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":"934315","type":"LOCAL"},{"code":"399832","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934315 = 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":"934312","type":"LOCAL"},{"code":"414070","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934312 = 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":"934314","type":"LOCAL"},{"code":"414071","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934314 = 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":"934318","type":"LOCAL"},{"code":"399837","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934318 = Hospital System Supply Identifier | 399837 = 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":"585337","type":"LOCAL"},{"code":"399836","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585337 = Hospital System Supply Identifier | 399836 = 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":"585336","type":"LOCAL"},{"code":"399835","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585336 = Hospital System Supply Identifier | 399835 = 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":"934317","type":"LOCAL"},{"code":"399834","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934317 = Hospital System Supply Identifier | 399834 = 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":"934316","type":"LOCAL"},{"code":"399833","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934316 = Hospital System Supply Identifier | 399833 = 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":"934319","type":"LOCAL"},{"code":"399838","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934319 = Hospital System Supply Identifier | 399838 = 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":"934320","type":"LOCAL"},{"code":"399839","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934320 = 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":"585338","type":"LOCAL"},{"code":"399840","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585338 = 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":"934321","type":"LOCAL"},{"code":"399841","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934321 = 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":"586785","type":"LOCAL"},{"code":"414072","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586785 = Hospital System Supply Identifier | 414072 = 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":"934324","type":"LOCAL"},{"code":"399845","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934324 = 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":"585339","type":"LOCAL"},{"code":"399844","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 585339 = Hospital System Supply Identifier | 399844 = 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":"934325","type":"LOCAL"},{"code":"399846","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934325 = Hospital System Supply Identifier | 399846 = 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":"934322","type":"LOCAL"},{"code":"399842","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934322 = 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":"934323","type":"LOCAL"},{"code":"399843","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934323 = 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":"934326","type":"LOCAL"},{"code":"399847","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934326 = 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":"934328","type":"LOCAL"},{"code":"399848","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934328 = 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":"586786","type":"LOCAL"},{"code":"414073","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586786 = Hospital System Supply Identifier | 414073 = 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":"586787","type":"LOCAL"},{"code":"414074","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586787 = Hospital System Supply Identifier | 414074 = 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":"586788","type":"LOCAL"},{"code":"414075","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 586788 = Hospital System Supply Identifier | 414075 = 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":"934329","type":"LOCAL"},{"code":"414076","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934329 = 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":"934330","type":"LOCAL"},{"code":"414077","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934330 = 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":"934331","type":"LOCAL"},{"code":"414078","type":"LOCAL"}],"standard_charges":[{"gross_charge":587.25,"discounted_cash":411.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934331 = Hospital System Supply Identifier | 414078 = 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":"934336","type":"LOCAL"},{"code":"414083","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934336 = Hospital System Supply Identifier | 414083 = 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":"934335","type":"LOCAL"},{"code":"414082","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934335 = Hospital System Supply Identifier | 414082 = 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":"934332","type":"LOCAL"},{"code":"414079","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934332 = 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":"934333","type":"LOCAL"},{"code":"414080","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934333 = 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":"934334","type":"LOCAL"},{"code":"414081","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934334 = Hospital System Supply Identifier | 414081 = 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":"934337","type":"LOCAL"},{"code":"414084","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934337 = 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":"934338","type":"LOCAL"},{"code":"414085","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934338 = 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":"934339","type":"LOCAL"},{"code":"414086","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934339 = 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":"934340","type":"LOCAL"},{"code":"414087","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934340 = 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":"934342","type":"LOCAL"},{"code":"414088","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934342 = 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":"934347","type":"LOCAL"},{"code":"414093","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934347 = 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":"934346","type":"LOCAL"},{"code":"414092","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934346 = 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":"934343","type":"LOCAL"},{"code":"414089","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934343 = 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":"934344","type":"LOCAL"},{"code":"414090","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934344 = 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":"934345","type":"LOCAL"},{"code":"414091","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934345 = 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":"934348","type":"LOCAL"},{"code":"414094","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934348 = 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":"934350","type":"LOCAL"},{"code":"414095","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934350 = 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":"934351","type":"LOCAL"},{"code":"414096","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934351 = 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":"934352","type":"LOCAL"},{"code":"414097","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934352 = 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":"934353","type":"LOCAL"},{"code":"414098","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934353 = 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":"934360","type":"LOCAL"},{"code":"414103","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934360 = 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":"934359","type":"LOCAL"},{"code":"414102","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934359 = Hospital System Supply Identifier | 414102 = 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":"934358","type":"LOCAL"},{"code":"414101","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934358 = Hospital System Supply Identifier | 414101 = 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":"934357","type":"LOCAL"},{"code":"414100","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934357 = 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":"934354","type":"LOCAL"},{"code":"414099","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934354 = Hospital System Supply Identifier | 414099 = 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":"934361","type":"LOCAL"},{"code":"414104","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934361 = 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":"934362","type":"LOCAL"},{"code":"414105","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934362 = 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":"934363","type":"LOCAL"},{"code":"414106","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934363 = 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":"934364","type":"LOCAL"},{"code":"414107","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934364 = 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":"934365","type":"LOCAL"},{"code":"414108","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934365 = 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":"934366","type":"LOCAL"},{"code":"414109","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934366 = Hospital System Supply Identifier | 414109 = 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":"934371","type":"LOCAL"},{"code":"414114","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934371 = 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":"934370","type":"LOCAL"},{"code":"414113","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934370 = Hospital System Supply Identifier | 414113 = 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":"934368","type":"LOCAL"},{"code":"414111","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934368 = Hospital System Supply Identifier | 414111 = 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":"934367","type":"LOCAL"},{"code":"414110","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934367 = 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":"934369","type":"LOCAL"},{"code":"414112","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934369 = Hospital System Supply Identifier | 414112 = 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":"934372","type":"LOCAL"},{"code":"414115","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934372 = 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":"934373","type":"LOCAL"},{"code":"414116","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934373 = 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":"934374","type":"LOCAL"},{"code":"414117","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934374 = Hospital System Supply Identifier | 414117 = 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":"934375","type":"LOCAL"},{"code":"414118","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934375 = Hospital System Supply Identifier | 414118 = 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":"934376","type":"LOCAL"},{"code":"414119","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934376 = Hospital System Supply Identifier | 414119 = 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":"934379","type":"LOCAL"},{"code":"414121","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934379 = Hospital System Supply Identifier | 414121 = 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":"934378","type":"LOCAL"},{"code":"414120","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934378 = Hospital System Supply Identifier | 414120 = 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":"934380","type":"LOCAL"},{"code":"414122","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934380 = Hospital System Supply Identifier | 414122 = 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":"934381","type":"LOCAL"},{"code":"414123","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934381 = Hospital System Supply Identifier | 414123 = 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":"934382","type":"LOCAL"},{"code":"414124","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934382 = Hospital System Supply Identifier | 414124 = 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":"934386","type":"LOCAL"},{"code":"414128","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934386 = Hospital System Supply Identifier | 414128 = 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":"934385","type":"LOCAL"},{"code":"414127","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934385 = Hospital System Supply Identifier | 414127 = 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":"934387","type":"LOCAL"},{"code":"414129","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934387 = Hospital System Supply Identifier | 414129 = 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":"934383","type":"LOCAL"},{"code":"414125","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934383 = 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":"934384","type":"LOCAL"},{"code":"414126","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934384 = Hospital System Supply Identifier | 414126 = 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":"934388","type":"LOCAL"},{"code":"414130","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934388 = Hospital System Supply Identifier | 414130 = 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":"934390","type":"LOCAL"},{"code":"414131","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934390 = Hospital System Supply Identifier | 414131 = 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":"934389","type":"LOCAL"},{"code":"410084","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934389 = Hospital System Supply Identifier | 410084 = 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":"934391","type":"LOCAL"},{"code":"414132","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934391 = 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":"934392","type":"LOCAL"},{"code":"414133","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934392 = 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":"934393","type":"LOCAL"},{"code":"414134","type":"LOCAL"}],"standard_charges":[{"gross_charge":10651.9,"discounted_cash":7456.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934393 = Hospital System Supply Identifier | 414134 = 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":"934394","type":"LOCAL"},{"code":"414135","type":"LOCAL"}],"standard_charges":[{"gross_charge":10872.82,"discounted_cash":7610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934394 = Hospital System Supply Identifier | 414135 = 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":"934395","type":"LOCAL"},{"code":"414136","type":"LOCAL"}],"standard_charges":[{"gross_charge":11750.53,"discounted_cash":8225.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934395 = Hospital System Supply Identifier | 414136 = 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":"934398","type":"LOCAL"},{"code":"414137","type":"LOCAL"}],"standard_charges":[{"gross_charge":12243.12,"discounted_cash":8570.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934398 = 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":"934400","type":"LOCAL"},{"code":"414139","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934400 = 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":"934399","type":"LOCAL"},{"code":"414138","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934399 = 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":"934405","type":"LOCAL"},{"code":"414142","type":"LOCAL"}],"standard_charges":[{"gross_charge":11750.53,"discounted_cash":8225.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934405 = 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":"934402","type":"LOCAL"},{"code":"414141","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934402 = Hospital System Supply Identifier | 414141 = 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":"934404","type":"LOCAL"},{"code":"410086","type":"LOCAL"}],"standard_charges":[{"gross_charge":10872.82,"discounted_cash":7610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934404 = Hospital System Supply Identifier | 410086 = 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":"934403","type":"LOCAL"},{"code":"410085","type":"LOCAL"}],"standard_charges":[{"gross_charge":10651.9,"discounted_cash":7456.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934403 = Hospital System Supply Identifier | 410085 = 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":"934401","type":"LOCAL"},{"code":"414140","type":"LOCAL"}],"standard_charges":[{"gross_charge":10416.06,"discounted_cash":7291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934401 = Hospital System Supply Identifier | 414140 = 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":"934406","type":"LOCAL"},{"code":"414143","type":"LOCAL"}],"standard_charges":[{"gross_charge":12243.12,"discounted_cash":8570.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934406 = Hospital System Supply Identifier | 414143 = 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":"934410","type":"LOCAL"},{"code":"414146","type":"LOCAL"}],"standard_charges":[{"gross_charge":7910.1,"discounted_cash":5537.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934410 = Hospital System Supply Identifier | 414146 = 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":"934409","type":"LOCAL"},{"code":"414145","type":"LOCAL"}],"standard_charges":[{"gross_charge":6726.12,"discounted_cash":4708.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934409 = Hospital System Supply Identifier | 414145 = 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":"934411","type":"LOCAL"},{"code":"414147","type":"LOCAL"}],"standard_charges":[{"gross_charge":8075.04,"discounted_cash":5652.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934411 = Hospital System Supply Identifier | 414147 = 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":"934407","type":"LOCAL"},{"code":"410087","type":"LOCAL"}],"standard_charges":[{"gross_charge":6246.54,"discounted_cash":4372.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934407 = 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":"934408","type":"LOCAL"},{"code":"414144","type":"LOCAL"}],"standard_charges":[{"gross_charge":6482.56,"discounted_cash":4537.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934408 = Hospital System Supply Identifier | 414144 = 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":"934416","type":"LOCAL"},{"code":"414152","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934416 = 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":"934415","type":"LOCAL"},{"code":"414151","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934415 = Hospital System Supply Identifier | 414151 = 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":"934412","type":"LOCAL"},{"code":"414148","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934412 = Hospital System Supply Identifier | 414148 = 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":"934413","type":"LOCAL"},{"code":"414149","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934413 = Hospital System Supply Identifier | 414149 = 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":"934414","type":"LOCAL"},{"code":"414150","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934414 = 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":"934418","type":"LOCAL"},{"code":"399849","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934418 = 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":"934420","type":"LOCAL"},{"code":"399850","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934420 = 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":"934417","type":"LOCAL"},{"code":"414153","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934417 = 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":"934419","type":"LOCAL"},{"code":"414154","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934419 = 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":"934421","type":"LOCAL"},{"code":"414155","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934421 = 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":"934426","type":"LOCAL"},{"code":"414159","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934426 = 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":"934425","type":"LOCAL"},{"code":"414158","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934425 = Hospital System Supply Identifier | 414158 = 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":"934422","type":"LOCAL"},{"code":"414156","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934422 = Hospital System Supply Identifier | 414156 = 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":"934423","type":"LOCAL"},{"code":"399851","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934423 = Hospital System Supply Identifier | 399851 = 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":"934424","type":"LOCAL"},{"code":"414157","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934424 = Hospital System Supply Identifier | 414157 = 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":"934427","type":"LOCAL"},{"code":"414160","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934427 = Hospital System Supply Identifier | 414160 = 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":"934428","type":"LOCAL"},{"code":"399852","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934428 = 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":"934429","type":"LOCAL"},{"code":"399853","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934429 = 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":"934431","type":"LOCAL"},{"code":"399854","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934431 = Hospital System Supply Identifier | 399854 = 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":"934430","type":"LOCAL"},{"code":"414161","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934430 = Hospital System Supply Identifier | 414161 = 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":"934437","type":"LOCAL"},{"code":"414164","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934437 = Hospital System Supply Identifier | 414164 = 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":"934432","type":"LOCAL"},{"code":"414162","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934432 = Hospital System Supply Identifier | 414162 = 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":"934435","type":"LOCAL"},{"code":"414163","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934435 = Hospital System Supply Identifier | 414163 = 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":"934433","type":"LOCAL"},{"code":"399855","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934433 = 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":"934434","type":"LOCAL"},{"code":"399856","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934434 = Hospital System Supply Identifier | 399856 = 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":"934438","type":"LOCAL"},{"code":"399857","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934438 = 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":"934439","type":"LOCAL"},{"code":"414165","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934439 = 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":"934440","type":"LOCAL"},{"code":"399858","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934440 = 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":"934441","type":"LOCAL"},{"code":"399859","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934441 = 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":"934442","type":"LOCAL"},{"code":"414166","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934442 = 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":"934443","type":"LOCAL"},{"code":"414167","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934443 = 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":"934444","type":"LOCAL"},{"code":"414168","type":"LOCAL"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934444 = Hospital System Supply Identifier | 414168 = 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":"934450","type":"LOCAL"},{"code":"414173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934450 = Hospital System Supply Identifier | 414173 = 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":"934449","type":"LOCAL"},{"code":"414172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934449 = Hospital System Supply Identifier | 414172 = 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":"934447","type":"LOCAL"},{"code":"414170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934447 = 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":"934445","type":"LOCAL"},{"code":"414169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934445 = 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":"934448","type":"LOCAL"},{"code":"414171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934448 = 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":"934456","type":"LOCAL"},{"code":"399860","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934456 = 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":"934457","type":"LOCAL"},{"code":"399861","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934457 = 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":"934451","type":"LOCAL"},{"code":"414174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934451 = 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":"934452","type":"LOCAL"},{"code":"414175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934452 = 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":"934453","type":"LOCAL"},{"code":"414176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934453 = 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":"934461","type":"LOCAL"},{"code":"414177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934461 = 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":"934462","type":"LOCAL"},{"code":"399865","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934462 = Hospital System Supply Identifier | 399865 = 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":"934459","type":"LOCAL"},{"code":"399863","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934459 = Hospital System Supply Identifier | 399863 = 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":"934458","type":"LOCAL"},{"code":"399862","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934458 = Hospital System Supply Identifier | 399862 = 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":"934460","type":"LOCAL"},{"code":"399864","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934460 = Hospital System Supply Identifier | 399864 = 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":"934464","type":"LOCAL"},{"code":"399866","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934464 = 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":"934465","type":"LOCAL"},{"code":"399867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934465 = 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":"934466","type":"LOCAL"},{"code":"399868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934466 = 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":"934467","type":"LOCAL"},{"code":"399869","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934467 = 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":"934463","type":"LOCAL"},{"code":"414178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934463 = Hospital System Supply Identifier | 414178 = 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":"934472","type":"LOCAL"},{"code":"399872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934472 = Hospital System Supply Identifier | 399872 = 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":"934469","type":"LOCAL"},{"code":"399870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934469 = 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":"934471","type":"LOCAL"},{"code":"399871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934471 = Hospital System Supply Identifier | 399871 = 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":"934468","type":"LOCAL"},{"code":"414179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934468 = Hospital System Supply Identifier | 414179 = 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":"934470","type":"LOCAL"},{"code":"414180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934470 = Hospital System Supply Identifier | 414180 = 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":"934473","type":"LOCAL"},{"code":"399873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934473 = 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":"934474","type":"LOCAL"},{"code":"399874","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934474 = 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":"934475","type":"LOCAL"},{"code":"414181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934475 = 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":"934476","type":"LOCAL"},{"code":"414182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934476 = Hospital System Supply Identifier | 414182 = 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":"934478","type":"LOCAL"},{"code":"414184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934478 = Hospital System Supply Identifier | 414184 = 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":"934477","type":"LOCAL"},{"code":"414183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934477 = Hospital System Supply Identifier | 414183 = 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":"934479","type":"LOCAL"},{"code":"414185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.4,"discounted_cash":892.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934479 = 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":"878169","type":"LOCAL"},{"code":"876836","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878169 = 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":"878168","type":"LOCAL"},{"code":"876835","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878168 = 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":"878170","type":"LOCAL"},{"code":"876837","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878170 = 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":"878171","type":"LOCAL"},{"code":"876838","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878171 = 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":"878172","type":"LOCAL"},{"code":"876839","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878172 = 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":"878173","type":"LOCAL"},{"code":"876840","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878173 = 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":"878174","type":"LOCAL"},{"code":"876841","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878174 = 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":"878175","type":"LOCAL"},{"code":"876842","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878175 = Hospital System Supply Identifier | 876842 = 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":"878177","type":"LOCAL"},{"code":"876844","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878177 = Hospital System Supply Identifier | 876844 = 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":"878176","type":"LOCAL"},{"code":"876843","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878176 = Hospital System Supply Identifier | 876843 = 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":"878178","type":"LOCAL"},{"code":"876845","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878178 = 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":"934480","type":"LOCAL"},{"code":"841865","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934480 = 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":"878179","type":"LOCAL"},{"code":"876846","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878179 = 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":"878180","type":"LOCAL"},{"code":"876847","type":"LOCAL"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":6259.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878180 = 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":"878181","type":"LOCAL"},{"code":"876848","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878181 = 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":"878182","type":"LOCAL"},{"code":"876849","type":"LOCAL"}],"standard_charges":[{"gross_charge":10626.0,"discounted_cash":7438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878182 = 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":"878183","type":"LOCAL"},{"code":"876850","type":"LOCAL"}],"standard_charges":[{"gross_charge":7703.62,"discounted_cash":5392.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878183 = 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":"878184","type":"LOCAL"},{"code":"876851","type":"LOCAL"}],"standard_charges":[{"gross_charge":7890.03,"discounted_cash":5523.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878184 = 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":"878185","type":"LOCAL"},{"code":"876852","type":"LOCAL"}],"standard_charges":[{"gross_charge":7893.94,"discounted_cash":5525.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878185 = Hospital System Supply Identifier | 876852 = 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":"878189","type":"LOCAL"},{"code":"876856","type":"LOCAL"}],"standard_charges":[{"gross_charge":9687.38,"discounted_cash":6781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878189 = Hospital System Supply Identifier | 876856 = 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":"878188","type":"LOCAL"},{"code":"876855","type":"LOCAL"}],"standard_charges":[{"gross_charge":8440.72,"discounted_cash":5908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878188 = Hospital System Supply Identifier | 876855 = 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":"878187","type":"LOCAL"},{"code":"876854","type":"LOCAL"}],"standard_charges":[{"gross_charge":8258.46,"discounted_cash":5780.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878187 = 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":"878186","type":"LOCAL"},{"code":"876853","type":"LOCAL"}],"standard_charges":[{"gross_charge":8076.2,"discounted_cash":5653.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878186 = 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":"878190","type":"LOCAL"},{"code":"876857","type":"LOCAL"}],"standard_charges":[{"gross_charge":7703.62,"discounted_cash":5392.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878190 = 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":"878191","type":"LOCAL"},{"code":"876858","type":"LOCAL"}],"standard_charges":[{"gross_charge":7890.03,"discounted_cash":5523.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878191 = 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":"878192","type":"LOCAL"},{"code":"876859","type":"LOCAL"}],"standard_charges":[{"gross_charge":7893.94,"discounted_cash":5525.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878192 = 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":"878193","type":"LOCAL"},{"code":"876860","type":"LOCAL"}],"standard_charges":[{"gross_charge":8076.2,"discounted_cash":5653.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878193 = 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":"878194","type":"LOCAL"},{"code":"876861","type":"LOCAL"}],"standard_charges":[{"gross_charge":8258.46,"discounted_cash":5780.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878194 = 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":"878195","type":"LOCAL"},{"code":"876862","type":"LOCAL"}],"standard_charges":[{"gross_charge":8440.72,"discounted_cash":5908.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878195 = 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":"878196","type":"LOCAL"},{"code":"876863","type":"LOCAL"}],"standard_charges":[{"gross_charge":9687.38,"discounted_cash":6781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878196 = 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":"878201","type":"LOCAL"},{"code":"876868","type":"LOCAL"}],"standard_charges":[{"gross_charge":7582.57,"discounted_cash":5307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878201 = 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":"878200","type":"LOCAL"},{"code":"876867","type":"LOCAL"}],"standard_charges":[{"gross_charge":7345.31,"discounted_cash":5141.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878200 = Hospital System Supply Identifier | 876867 = 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":"878197","type":"LOCAL"},{"code":"876864","type":"LOCAL"}],"standard_charges":[{"gross_charge":5865.74,"discounted_cash":4106.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878197 = Hospital System Supply Identifier | 876864 = 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":"878198","type":"LOCAL"},{"code":"876865","type":"LOCAL"}],"standard_charges":[{"gross_charge":6097.51,"discounted_cash":4268.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878198 = Hospital System Supply Identifier | 876865 = 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":"878199","type":"LOCAL"},{"code":"876866","type":"LOCAL"}],"standard_charges":[{"gross_charge":6357.34,"discounted_cash":4450.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878199 = 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":"878202","type":"LOCAL"},{"code":"876869","type":"LOCAL"}],"standard_charges":[{"gross_charge":8845.47,"discounted_cash":6191.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878202 = 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":"878203","type":"LOCAL"},{"code":"876870","type":"LOCAL"}],"standard_charges":[{"gross_charge":9070.34,"discounted_cash":6349.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878203 = 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":"878204","type":"LOCAL"},{"code":"876871","type":"LOCAL"}],"standard_charges":[{"gross_charge":9120.81,"discounted_cash":6384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878204 = 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":"878208","type":"LOCAL"},{"code":"876875","type":"LOCAL"}],"standard_charges":[{"gross_charge":10273.82,"discounted_cash":7191.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878208 = Hospital System Supply Identifier | 876875 = 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":"878207","type":"LOCAL"},{"code":"876874","type":"LOCAL"}],"standard_charges":[{"gross_charge":10265.56,"discounted_cash":7185.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878207 = 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":"878209","type":"LOCAL"},{"code":"876876","type":"LOCAL"}],"standard_charges":[{"gross_charge":11104.92,"discounted_cash":7773.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878209 = Hospital System Supply Identifier | 876876 = 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":"878205","type":"LOCAL"},{"code":"876872","type":"LOCAL"}],"standard_charges":[{"gross_charge":9808.12,"discounted_cash":6865.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878205 = 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":"878206","type":"LOCAL"},{"code":"876873","type":"LOCAL"}],"standard_charges":[{"gross_charge":10038.0,"discounted_cash":7026.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878206 = Hospital System Supply Identifier | 876873 = 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":"878211","type":"LOCAL"},{"code":"876878","type":"LOCAL"}],"standard_charges":[{"gross_charge":9070.34,"discounted_cash":6349.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878211 = Hospital System Supply Identifier | 876878 = 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":"878212","type":"LOCAL"},{"code":"876879","type":"LOCAL"}],"standard_charges":[{"gross_charge":9120.81,"discounted_cash":6384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878212 = 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":"878210","type":"LOCAL"},{"code":"876877","type":"LOCAL"}],"standard_charges":[{"gross_charge":8845.47,"discounted_cash":6191.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878210 = Hospital System Supply Identifier | 876877 = 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":"878213","type":"LOCAL"},{"code":"876880","type":"LOCAL"}],"standard_charges":[{"gross_charge":9808.12,"discounted_cash":6865.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878213 = 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":"878214","type":"LOCAL"},{"code":"876881","type":"LOCAL"}],"standard_charges":[{"gross_charge":10038.0,"discounted_cash":7026.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878214 = 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":"878215","type":"LOCAL"},{"code":"876882","type":"LOCAL"}],"standard_charges":[{"gross_charge":10265.56,"discounted_cash":7185.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878215 = Hospital System Supply Identifier | 876882 = 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":"878216","type":"LOCAL"},{"code":"876883","type":"LOCAL"}],"standard_charges":[{"gross_charge":10273.82,"discounted_cash":7191.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878216 = Hospital System Supply Identifier | 876883 = 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":"878217","type":"LOCAL"},{"code":"876884","type":"LOCAL"}],"standard_charges":[{"gross_charge":11104.92,"discounted_cash":7773.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878217 = Hospital System Supply Identifier | 876884 = 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":"878221","type":"LOCAL"},{"code":"876888","type":"LOCAL"}],"standard_charges":[{"gross_charge":7476.04,"discounted_cash":5233.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878221 = Hospital System Supply Identifier | 876888 = 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":"878220","type":"LOCAL"},{"code":"876887","type":"LOCAL"}],"standard_charges":[{"gross_charge":6473.25,"discounted_cash":4531.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878220 = Hospital System Supply Identifier | 876887 = 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":"878222","type":"LOCAL"},{"code":"876889","type":"LOCAL"}],"standard_charges":[{"gross_charge":7805.3,"discounted_cash":5463.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878222 = Hospital System Supply Identifier | 876889 = 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":"878218","type":"LOCAL"},{"code":"876885","type":"LOCAL"}],"standard_charges":[{"gross_charge":6097.51,"discounted_cash":4268.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878218 = Hospital System Supply Identifier | 876885 = 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":"878219","type":"LOCAL"},{"code":"876886","type":"LOCAL"}],"standard_charges":[{"gross_charge":6326.74,"discounted_cash":4428.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878219 = Hospital System Supply Identifier | 876886 = 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":"878223","type":"LOCAL"},{"code":"876890","type":"LOCAL"}],"standard_charges":[{"gross_charge":4602.59,"discounted_cash":3221.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878223 = 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":"878224","type":"LOCAL"},{"code":"876891","type":"LOCAL"}],"standard_charges":[{"gross_charge":5228.37,"discounted_cash":3659.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878224 = 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":"878225","type":"LOCAL"},{"code":"876892","type":"LOCAL"}],"standard_charges":[{"gross_charge":5681.73,"discounted_cash":3977.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878225 = 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":"878226","type":"LOCAL"},{"code":"876893","type":"LOCAL"}],"standard_charges":[{"gross_charge":6097.51,"discounted_cash":4268.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878226 = 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":"878227","type":"LOCAL"},{"code":"876894","type":"LOCAL"}],"standard_charges":[{"gross_charge":6473.25,"discounted_cash":4531.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878227 = 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":"878228","type":"LOCAL"},{"code":"876895","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878228 = 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":"878229","type":"LOCAL"},{"code":"876896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878229 = 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":"878230","type":"LOCAL"},{"code":"876897","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878230 = Hospital System Supply Identifier | 876897 = 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":"878232","type":"LOCAL"},{"code":"876899","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878232 = Hospital System Supply Identifier | 876899 = 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":"878231","type":"LOCAL"},{"code":"876898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878231 = Hospital System Supply Identifier | 876898 = 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":"878234","type":"LOCAL"},{"code":"876901","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878234 = Hospital System Supply Identifier | 876901 = 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":"878233","type":"LOCAL"},{"code":"876900","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878233 = Hospital System Supply Identifier | 876900 = 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":"878235","type":"LOCAL"},{"code":"876902","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878235 = 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":"878236","type":"LOCAL"},{"code":"876903","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878236 = Hospital System Supply Identifier | 876903 = 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":"878237","type":"LOCAL"},{"code":"876904","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878237 = Hospital System Supply Identifier | 876904 = 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":"878238","type":"LOCAL"},{"code":"876905","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878238 = Hospital System Supply Identifier | 876905 = 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":"878239","type":"LOCAL"},{"code":"876906","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878239 = Hospital System Supply Identifier | 876906 = 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":"878240","type":"LOCAL"},{"code":"876907","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878240 = Hospital System Supply Identifier | 876907 = 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":"878241","type":"LOCAL"},{"code":"876908","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878241 = 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":"878244","type":"LOCAL"},{"code":"876909","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878244 = Hospital System Supply Identifier | 876909 = 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":"878246","type":"LOCAL"},{"code":"876911","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878246 = Hospital System Supply Identifier | 876911 = 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":"878245","type":"LOCAL"},{"code":"876910","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878245 = Hospital System Supply Identifier | 876910 = 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":"878247","type":"LOCAL"},{"code":"876912","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878247 = 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":"878248","type":"LOCAL"},{"code":"876913","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878248 = 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":"878249","type":"LOCAL"},{"code":"876914","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878249 = 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":"878250","type":"LOCAL"},{"code":"876915","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878250 = 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":"878251","type":"LOCAL"},{"code":"876916","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878251 = Hospital System Supply Identifier | 876916 = 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":"878252","type":"LOCAL"},{"code":"876917","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878252 = Hospital System Supply Identifier | 876917 = 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":"878253","type":"LOCAL"},{"code":"876918","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878253 = Hospital System Supply Identifier | 876918 = 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":"878255","type":"LOCAL"},{"code":"876920","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878255 = Hospital System Supply Identifier | 876920 = 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":"878254","type":"LOCAL"},{"code":"876919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878254 = Hospital System Supply Identifier | 876919 = 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":"878257","type":"LOCAL"},{"code":"876922","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878257 = Hospital System Supply Identifier | 876922 = 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":"878256","type":"LOCAL"},{"code":"876921","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878256 = Hospital System Supply Identifier | 876921 = 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":"878258","type":"LOCAL"},{"code":"876923","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878258 = 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":"878259","type":"LOCAL"},{"code":"876924","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878259 = 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":"878260","type":"LOCAL"},{"code":"876925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878260 = 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":"878261","type":"LOCAL"},{"code":"876926","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878261 = Hospital System Supply Identifier | 876926 = 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":"878262","type":"LOCAL"},{"code":"876927","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878262 = Hospital System Supply Identifier | 876927 = 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":"878263","type":"LOCAL"},{"code":"876928","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878263 = Hospital System Supply Identifier | 876928 = 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":"878264","type":"LOCAL"},{"code":"876929","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878264 = 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":"878265","type":"LOCAL"},{"code":"876930","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878265 = 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":"878266","type":"LOCAL"},{"code":"876931","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878266 = Hospital System Supply Identifier | 876931 = 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":"878268","type":"LOCAL"},{"code":"876933","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878268 = Hospital System Supply Identifier | 876933 = 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":"878267","type":"LOCAL"},{"code":"876932","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878267 = Hospital System Supply Identifier | 876932 = 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":"878269","type":"LOCAL"},{"code":"876934","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878269 = 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":"878270","type":"LOCAL"},{"code":"876935","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878270 = 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":"878271","type":"LOCAL"},{"code":"876936","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878271 = 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":"878272","type":"LOCAL"},{"code":"876937","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878272 = Hospital System Supply Identifier | 876937 = 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":"878273","type":"LOCAL"},{"code":"876938","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878273 = Hospital System Supply Identifier | 876938 = 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":"878274","type":"LOCAL"},{"code":"876939","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878274 = Hospital System Supply Identifier | 876939 = 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":"878275","type":"LOCAL"},{"code":"876940","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878275 = 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":"878276","type":"LOCAL"},{"code":"876941","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878276 = Hospital System Supply Identifier | 876941 = 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":"878278","type":"LOCAL"},{"code":"876943","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878278 = Hospital System Supply Identifier | 876943 = 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":"878277","type":"LOCAL"},{"code":"876942","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878277 = Hospital System Supply Identifier | 876942 = 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":"878279","type":"LOCAL"},{"code":"876944","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878279 = 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":"878280","type":"LOCAL"},{"code":"876945","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878280 = 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":"878281","type":"LOCAL"},{"code":"876946","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878281 = 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":"878282","type":"LOCAL"},{"code":"876947","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878282 = 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":"878283","type":"LOCAL"},{"code":"876948","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878283 = Hospital System Supply Identifier | 876948 = 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":"878288","type":"LOCAL"},{"code":"876953","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878288 = 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":"878289","type":"LOCAL"},{"code":"876954","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878289 = Hospital System Supply Identifier | 876954 = 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":"878287","type":"LOCAL"},{"code":"876952","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878287 = Hospital System Supply Identifier | 876952 = 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":"878285","type":"LOCAL"},{"code":"876950","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878285 = Hospital System Supply Identifier | 876950 = 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":"878284","type":"LOCAL"},{"code":"876949","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878284 = Hospital System Supply Identifier | 876949 = 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":"878286","type":"LOCAL"},{"code":"876951","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878286 = Hospital System Supply Identifier | 876951 = 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":"878295","type":"LOCAL"},{"code":"876960","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878295 = Hospital System Supply Identifier | 876960 = 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":"878290","type":"LOCAL"},{"code":"876955","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878290 = Hospital System Supply Identifier | 876955 = 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":"878291","type":"LOCAL"},{"code":"876956","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878291 = Hospital System Supply Identifier | 876956 = 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":"878292","type":"LOCAL"},{"code":"876957","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878292 = Hospital System Supply Identifier | 876957 = 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":"878293","type":"LOCAL"},{"code":"876958","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878293 = Hospital System Supply Identifier | 876958 = 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":"878294","type":"LOCAL"},{"code":"876959","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878294 = Hospital System Supply Identifier | 876959 = 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":"878296","type":"LOCAL"},{"code":"876961","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878296 = Hospital System Supply Identifier | 876961 = 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":"878300","type":"LOCAL"},{"code":"876965","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878300 = Hospital System Supply Identifier | 876965 = 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":"878301","type":"LOCAL"},{"code":"876966","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878301 = Hospital System Supply Identifier | 876966 = 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":"878299","type":"LOCAL"},{"code":"876964","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878299 = Hospital System Supply Identifier | 876964 = 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":"878298","type":"LOCAL"},{"code":"876963","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878298 = Hospital System Supply Identifier | 876963 = 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":"878297","type":"LOCAL"},{"code":"876962","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878297 = Hospital System Supply Identifier | 876962 = 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":"878302","type":"LOCAL"},{"code":"876967","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878302 = Hospital System Supply Identifier | 876967 = 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":"878303","type":"LOCAL"},{"code":"876968","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878303 = Hospital System Supply Identifier | 876968 = 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":"878304","type":"LOCAL"},{"code":"876969","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878304 = Hospital System Supply Identifier | 876969 = 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":"878314","type":"LOCAL"},{"code":"876979","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878314 = Hospital System Supply Identifier | 876979 = 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":"878313","type":"LOCAL"},{"code":"876978","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878313 = Hospital System Supply Identifier | 876978 = 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":"878312","type":"LOCAL"},{"code":"876977","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878312 = Hospital System Supply Identifier | 876977 = 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":"878311","type":"LOCAL"},{"code":"876976","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878311 = 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":"878310","type":"LOCAL"},{"code":"876975","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878310 = Hospital System Supply Identifier | 876975 = 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":"878309","type":"LOCAL"},{"code":"876974","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878309 = Hospital System Supply Identifier | 876974 = 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":"878308","type":"LOCAL"},{"code":"876973","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878308 = 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":"878307","type":"LOCAL"},{"code":"876972","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878307 = 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":"878306","type":"LOCAL"},{"code":"876971","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878306 = 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":"878305","type":"LOCAL"},{"code":"876970","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878305 = Hospital System Supply Identifier | 876970 = 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":"878320","type":"LOCAL"},{"code":"876985","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878320 = Hospital System Supply Identifier | 876985 = 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":"878319","type":"LOCAL"},{"code":"876984","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878319 = Hospital System Supply Identifier | 876984 = 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":"878318","type":"LOCAL"},{"code":"876983","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878318 = Hospital System Supply Identifier | 876983 = 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":"878321","type":"LOCAL"},{"code":"876986","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878321 = Hospital System Supply Identifier | 876986 = 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":"878316","type":"LOCAL"},{"code":"876981","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878316 = Hospital System Supply Identifier | 876981 = 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":"878315","type":"LOCAL"},{"code":"876980","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878315 = Hospital System Supply Identifier | 876980 = 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":"878317","type":"LOCAL"},{"code":"876982","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878317 = Hospital System Supply Identifier | 876982 = 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":"878322","type":"LOCAL"},{"code":"876987","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878322 = 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":"878323","type":"LOCAL"},{"code":"876988","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878323 = Hospital System Supply Identifier | 876988 = 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":"878324","type":"LOCAL"},{"code":"876989","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878324 = Hospital System Supply Identifier | 876989 = 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":"878325","type":"LOCAL"},{"code":"876990","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878325 = Hospital System Supply Identifier | 876990 = 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":"878326","type":"LOCAL"},{"code":"876991","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878326 = Hospital System Supply Identifier | 876991 = 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":"878327","type":"LOCAL"},{"code":"876992","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878327 = 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":"878328","type":"LOCAL"},{"code":"876993","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878328 = 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":"878329","type":"LOCAL"},{"code":"876994","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878329 = 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":"878334","type":"LOCAL"},{"code":"876999","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878334 = Hospital System Supply Identifier | 876999 = 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":"878333","type":"LOCAL"},{"code":"876998","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878333 = 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":"878330","type":"LOCAL"},{"code":"876995","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878330 = 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":"878331","type":"LOCAL"},{"code":"876996","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878331 = Hospital System Supply Identifier | 876996 = 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":"878332","type":"LOCAL"},{"code":"876997","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878332 = Hospital System Supply Identifier | 876997 = 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":"878335","type":"LOCAL"},{"code":"877000","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878335 = 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":"878336","type":"LOCAL"},{"code":"877001","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878336 = 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":"878337","type":"LOCAL"},{"code":"877002","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878337 = 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":"878338","type":"LOCAL"},{"code":"877003","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878338 = 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":"878339","type":"LOCAL"},{"code":"877004","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878339 = 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":"878344","type":"LOCAL"},{"code":"877009","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878344 = Hospital System Supply Identifier | 877009 = 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":"878345","type":"LOCAL"},{"code":"877010","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878345 = Hospital System Supply Identifier | 877010 = 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":"878343","type":"LOCAL"},{"code":"877008","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878343 = Hospital System Supply Identifier | 877008 = 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":"878341","type":"LOCAL"},{"code":"877006","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878341 = Hospital System Supply Identifier | 877006 = 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":"878342","type":"LOCAL"},{"code":"877007","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878342 = Hospital System Supply Identifier | 877007 = 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":"878340","type":"LOCAL"},{"code":"877005","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878340 = Hospital System Supply Identifier | 877005 = 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":"878346","type":"LOCAL"},{"code":"877011","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878346 = 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":"878347","type":"LOCAL"},{"code":"877012","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878347 = 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":"878348","type":"LOCAL"},{"code":"877013","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878348 = 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":"878349","type":"LOCAL"},{"code":"877014","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878349 = 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":"878350","type":"LOCAL"},{"code":"877015","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878350 = 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":"878351","type":"LOCAL"},{"code":"877016","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878351 = Hospital System Supply Identifier | 877016 = 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":"878353","type":"LOCAL"},{"code":"877018","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878353 = Hospital System Supply Identifier | 877018 = 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":"878352","type":"LOCAL"},{"code":"877017","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878352 = Hospital System Supply Identifier | 877017 = 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":"878354","type":"LOCAL"},{"code":"877019","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878354 = 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":"878355","type":"LOCAL"},{"code":"877020","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878355 = 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":"878356","type":"LOCAL"},{"code":"877021","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878356 = 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":"878357","type":"LOCAL"},{"code":"877022","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878357 = 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":"878358","type":"LOCAL"},{"code":"877023","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878358 = 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":"878359","type":"LOCAL"},{"code":"877024","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878359 = Hospital System Supply Identifier | 877024 = 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":"878364","type":"LOCAL"},{"code":"877029","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878364 = Hospital System Supply Identifier | 877029 = 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":"878363","type":"LOCAL"},{"code":"877028","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878363 = Hospital System Supply Identifier | 877028 = 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":"878361","type":"LOCAL"},{"code":"877026","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878361 = Hospital System Supply Identifier | 877026 = 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":"878360","type":"LOCAL"},{"code":"877025","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878360 = Hospital System Supply Identifier | 877025 = 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":"878362","type":"LOCAL"},{"code":"877027","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878362 = Hospital System Supply Identifier | 877027 = 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":"878365","type":"LOCAL"},{"code":"877030","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878365 = 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":"878366","type":"LOCAL"},{"code":"877031","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878366 = 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":"878367","type":"LOCAL"},{"code":"877032","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878367 = 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":"878368","type":"LOCAL"},{"code":"877033","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878368 = 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":"878369","type":"LOCAL"},{"code":"877034","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878369 = 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":"878370","type":"LOCAL"},{"code":"877035","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878370 = 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":"878371","type":"LOCAL"},{"code":"877036","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878371 = 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":"878372","type":"LOCAL"},{"code":"877037","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878372 = Hospital System Supply Identifier | 877037 = 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":"878377","type":"LOCAL"},{"code":"877042","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878377 = 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":"878373","type":"LOCAL"},{"code":"877038","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878373 = 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":"878374","type":"LOCAL"},{"code":"877039","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878374 = Hospital System Supply Identifier | 877039 = 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":"878375","type":"LOCAL"},{"code":"877040","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878375 = Hospital System Supply Identifier | 877040 = 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":"878376","type":"LOCAL"},{"code":"877041","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878376 = Hospital System Supply Identifier | 877041 = 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":"878380","type":"LOCAL"},{"code":"877045","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878380 = 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":"878381","type":"LOCAL"},{"code":"877046","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878381 = Hospital System Supply Identifier | 877046 = 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":"878378","type":"LOCAL"},{"code":"877043","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878378 = 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":"878379","type":"LOCAL"},{"code":"877044","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878379 = Hospital System Supply Identifier | 877044 = 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":"878382","type":"LOCAL"},{"code":"877047","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878382 = Hospital System Supply Identifier | 877047 = 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":"878384","type":"LOCAL"},{"code":"877049","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878384 = Hospital System Supply Identifier | 877049 = 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":"878387","type":"LOCAL"},{"code":"877052","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878387 = Hospital System Supply Identifier | 877052 = 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":"878386","type":"LOCAL"},{"code":"877051","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878386 = 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":"878383","type":"LOCAL"},{"code":"877048","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878383 = Hospital System Supply Identifier | 877048 = 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":"878385","type":"LOCAL"},{"code":"877050","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878385 = Hospital System Supply Identifier | 877050 = 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":"878388","type":"LOCAL"},{"code":"877053","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878388 = Hospital System Supply Identifier | 877053 = 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":"878389","type":"LOCAL"},{"code":"877054","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878389 = Hospital System Supply Identifier | 877054 = 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":"878390","type":"LOCAL"},{"code":"877055","type":"LOCAL"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878390 = 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":"36476","type":"LOCAL"},{"code":"100111","type":"LOCAL"}],"standard_charges":[{"gross_charge":295.36,"discounted_cash":206.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36476 = Hospital System Supply Identifier | 100111 = Lawson ID"}]},{"description":"CEM BONE PALACOS-R 40GM","code_information":[{"code":"Sx00-1112-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"3358","type":"LOCAL"},{"code":"141046","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.25,"discounted_cash":167.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 3358 = Hospital System Supply Identifier | 141046 = 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":"12496","type":"LOCAL"},{"code":"238388","type":"LOCAL"}],"standard_charges":[{"gross_charge":826.5,"discounted_cash":578.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 12496 = 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":"26755","type":"LOCAL"},{"code":"308782","type":"LOCAL"}],"standard_charges":[{"gross_charge":239.25,"discounted_cash":167.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 26755 = 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":"26756","type":"LOCAL"},{"code":"308783","type":"LOCAL"}],"standard_charges":[{"gross_charge":826.5,"discounted_cash":578.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 26756 = 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":"12266","type":"LOCAL"},{"code":"237164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":764.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 12266 = 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":"383160","type":"LOCAL"},{"code":"148674","type":"LOCAL"}],"standard_charges":[{"gross_charge":739.5,"discounted_cash":517.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383160 = Hospital System Supply Identifier | 148674 = Lawson ID"}]},{"description":"DISC - SCREW DEPTH GAUGE FOR 4.0","code_information":[{"code":"Sx00-1142-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"12111","type":"LOCAL"},{"code":"236519","type":"LOCAL"}],"standard_charges":[{"gross_charge":704.7,"discounted_cash":493.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 12111 = Hospital System Supply Identifier | 236519 = 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":"1991","type":"LOCAL"},{"code":"339432","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1991 = 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":"1990","type":"LOCAL"},{"code":"339431","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1990 = 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":"1989","type":"LOCAL"},{"code":"339430","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1989 = Hospital System Supply Identifier | 339430 = 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":"30843","type":"LOCAL"},{"code":"323779","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 30843 = Hospital System Supply Identifier | 323779 = 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":"11918","type":"LOCAL"},{"code":"235490","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11918 = Hospital System Supply Identifier | 235490 = 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":"11920","type":"LOCAL"},{"code":"235492","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11920 = Hospital System Supply Identifier | 235492 = 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":"11919","type":"LOCAL"},{"code":"235491","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11919 = Hospital System Supply Identifier | 235491 = 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":"11921","type":"LOCAL"},{"code":"235493","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11921 = Hospital System Supply Identifier | 235493 = 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":"1999","type":"LOCAL"},{"code":"339437","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1999 = Hospital System Supply Identifier | 339437 = 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":"1995","type":"LOCAL"},{"code":"339436","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1995 = Hospital System Supply Identifier | 339436 = 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":"11932","type":"LOCAL"},{"code":"235504","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11932 = Hospital System Supply Identifier | 235504 = 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":"1994","type":"LOCAL"},{"code":"339435","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1994 = Hospital System Supply Identifier | 339435 = 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":"1993","type":"LOCAL"},{"code":"339434","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1993 = Hospital System Supply Identifier | 339434 = 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":"11931","type":"LOCAL"},{"code":"235503","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11931 = Hospital System Supply Identifier | 235503 = 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":"11925","type":"LOCAL"},{"code":"235497","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11925 = Hospital System Supply Identifier | 235497 = 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":"11929","type":"LOCAL"},{"code":"235501","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11929 = 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":"11928","type":"LOCAL"},{"code":"235500","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11928 = Hospital System Supply Identifier | 235500 = 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":"11927","type":"LOCAL"},{"code":"235499","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11927 = Hospital System Supply Identifier | 235499 = 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":"11926","type":"LOCAL"},{"code":"235498","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11926 = Hospital System Supply Identifier | 235498 = 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":"11924","type":"LOCAL"},{"code":"235496","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11924 = 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":"11930","type":"LOCAL"},{"code":"235502","type":"LOCAL"}],"standard_charges":[{"gross_charge":695.52,"discounted_cash":486.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11930 = Hospital System Supply Identifier | 235502 = 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":"2005","type":"LOCAL"},{"code":"339443","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2005 = Hospital System Supply Identifier | 339443 = 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":"11942","type":"LOCAL"},{"code":"235526","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11942 = 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":"11943","type":"LOCAL"},{"code":"235527","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11943 = 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":"11944","type":"LOCAL"},{"code":"235528","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 11944 = 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":"2001","type":"LOCAL"},{"code":"339439","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2001 = 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":"2002","type":"LOCAL"},{"code":"339440","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2002 = Hospital System Supply Identifier | 339440 = 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":"36623","type":"LOCAL"},{"code":"116084","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36623 = Hospital System Supply Identifier | 116084 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X46","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36619","type":"LOCAL"},{"code":"116080","type":"LOCAL"}],"standard_charges":[{"gross_charge":761.07,"discounted_cash":532.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36619 = Hospital System Supply Identifier | 116080 = 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":"36624","type":"LOCAL"},{"code":"116086","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36624 = Hospital System Supply Identifier | 116086 = 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":"36622","type":"LOCAL"},{"code":"116083","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36622 = Hospital System Supply Identifier | 116083 = 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":"36613","type":"LOCAL"},{"code":"116073","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36613 = Hospital System Supply Identifier | 116073 = 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":"36620","type":"LOCAL"},{"code":"116081","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36620 = Hospital System Supply Identifier | 116081 = 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":"36621","type":"LOCAL"},{"code":"116082","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36621 = Hospital System Supply Identifier | 116082 = 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":"36611","type":"LOCAL"},{"code":"116071","type":"LOCAL"}],"standard_charges":[{"gross_charge":706.87,"discounted_cash":494.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 36611 = 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":"383171","type":"LOCAL"},{"code":"202373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383171 = 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":"67780","type":"LOCAL"},{"code":"201497","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 67780 = 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":"68016","type":"LOCAL"},{"code":"205031","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68016 = 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":"67738","type":"LOCAL"},{"code":"201197","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 67738 = Hospital System Supply Identifier | 201197 = 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":"2173","type":"LOCAL"},{"code":"339795","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2173 = Hospital System Supply Identifier | 339795 = 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":"67766","type":"LOCAL"},{"code":"201359","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 67766 = Hospital System Supply Identifier | 201359 = 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":"52518","type":"LOCAL"},{"code":"116091","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52518 = 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":"52519","type":"LOCAL"},{"code":"116092","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52519 = 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":"53341","type":"LOCAL"},{"code":"201198","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 53341 = 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":"2174","type":"LOCAL"},{"code":"339796","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2174 = Hospital System Supply Identifier | 339796 = 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":"67752","type":"LOCAL"},{"code":"201293","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 67752 = 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":"2175","type":"LOCAL"},{"code":"339797","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2175 = Hospital System Supply Identifier | 339797 = 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":"67765","type":"LOCAL"},{"code":"201358","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 67765 = 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":"2177","type":"LOCAL"},{"code":"339799","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2177 = Hospital System Supply Identifier | 339799 = 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":"2178","type":"LOCAL"},{"code":"339800","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2178 = 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":"2179","type":"LOCAL"},{"code":"339801","type":"LOCAL"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2179 = 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":"5205","type":"LOCAL"},{"code":"343898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1256.32,"discounted_cash":879.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 5205 = 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":"5226","type":"LOCAL"},{"code":"343919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1256.32,"discounted_cash":879.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 5226 = 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":"383571","type":"LOCAL"},{"code":"395445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1008.64,"discounted_cash":706.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383571 = 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":"27463","type":"LOCAL"},{"code":"314877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1032.28,"discounted_cash":722.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 27463 = 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":"383369","type":"LOCAL"},{"code":"393263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383369 = 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":"2185","type":"LOCAL"},{"code":"339806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2185 = 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":"383336","type":"LOCAL"},{"code":"387535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 383336 = 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":"27312","type":"LOCAL"},{"code":"314162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 27312 = 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":"5202","type":"LOCAL"},{"code":"343895","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 5202 = 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":"384883","type":"LOCAL"},{"code":"461757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1351.35,"discounted_cash":945.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384883 = Hospital System Supply Identifier | 461757 = Lawson ID"}]},{"description":"PIN GDE CLUS","code_information":[{"code":"Sx00-1147-061","type":"CDM"},{"code":"272","type":"RC"},{"code":"5231","type":"LOCAL"},{"code":"343924","type":"LOCAL"}],"standard_charges":[{"gross_charge":3432.05,"discounted_cash":2402.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 5231 = Hospital System Supply Identifier | 343924 = Lawson ID"}]},{"description":"FCP SCREW HLDING","code_information":[{"code":"Sx00-1147-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"5203","type":"LOCAL"},{"code":"343896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1114.88,"discounted_cash":780.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 5203 = 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":"669332","type":"LOCAL"},{"code":"732743","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 669332 = 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":"23375","type":"LOCAL"},{"code":"250825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1389.37,"discounted_cash":972.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 23375 = 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":"52463","type":"LOCAL"},{"code":"114304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52463 = 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":"52464","type":"LOCAL"},{"code":"114305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52464 = 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":"53275","type":"LOCAL"},{"code":"145717","type":"LOCAL"}],"standard_charges":[{"gross_charge":698.39,"discounted_cash":488.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 53275 = 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":"52465","type":"LOCAL"},{"code":"114306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52465 = 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":"28320","type":"LOCAL"},{"code":"124103","type":"LOCAL"}],"standard_charges":[{"gross_charge":1795.95,"discounted_cash":1257.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 28320 = 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":"52466","type":"LOCAL"},{"code":"114307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52466 = 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":"4171","type":"LOCAL"},{"code":"154038","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 4171 = 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":"52467","type":"LOCAL"},{"code":"114309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52467 = 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":"52468","type":"LOCAL"},{"code":"114310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52468 = 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":"52469","type":"LOCAL"},{"code":"114311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52469 = 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":"52470","type":"LOCAL"},{"code":"114312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1312.8,"discounted_cash":918.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52470 = 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":"2330","type":"LOCAL"},{"code":"339884","type":"LOCAL"}],"standard_charges":[{"gross_charge":1692.9,"discounted_cash":1185.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2330 = 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":"2329","type":"LOCAL"},{"code":"339883","type":"LOCAL"}],"standard_charges":[{"gross_charge":1510.16,"discounted_cash":1057.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2329 = 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":"2328","type":"LOCAL"},{"code":"339882","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.12,"discounted_cash":969.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2328 = 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":"2327","type":"LOCAL"},{"code":"339881","type":"LOCAL"}],"standard_charges":[{"gross_charge":1292.76,"discounted_cash":904.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2327 = 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":"2326","type":"LOCAL"},{"code":"339880","type":"LOCAL"}],"standard_charges":[{"gross_charge":1046.52,"discounted_cash":732.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2326 = Hospital System Supply Identifier | 339880 = 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":"2324","type":"LOCAL"},{"code":"339878","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.48,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2324 = 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":"2323","type":"LOCAL"},{"code":"339877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.48,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2323 = 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":"2322","type":"LOCAL"},{"code":"339876","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.48,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2322 = 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":"2321","type":"LOCAL"},{"code":"339875","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.48,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2321 = Hospital System Supply Identifier | 339875 = 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":"2325","type":"LOCAL"},{"code":"339879","type":"LOCAL"}],"standard_charges":[{"gross_charge":1020.48,"discounted_cash":714.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 2325 = Hospital System Supply Identifier | 339879 = 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":"52732","type":"LOCAL"},{"code":"201370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52732 = 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":"52737","type":"LOCAL"},{"code":"201833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52737 = 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":"52715","type":"LOCAL"},{"code":"200695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52715 = 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":"52774","type":"LOCAL"},{"code":"203357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52774 = Hospital System Supply Identifier | 203357 = 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":"52719","type":"LOCAL"},{"code":"201155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52719 = Hospital System Supply Identifier | 201155 = 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":"52777","type":"LOCAL"},{"code":"203361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52777 = Hospital System Supply Identifier | 203361 = 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":"52787","type":"LOCAL"},{"code":"204507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52787 = Hospital System Supply Identifier | 204507 = 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":"52722","type":"LOCAL"},{"code":"201175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52722 = Hospital System Supply Identifier | 201175 = 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":"37511","type":"LOCAL"},{"code":"201531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 37511 = 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":"52796","type":"LOCAL"},{"code":"204516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1420.57,"discounted_cash":994.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 52796 = 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":"21378","type":"LOCAL"},{"code":"103817","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 21378 = 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":"28567","type":"LOCAL"},{"code":"131618","type":"LOCAL"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 28567 = 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":"384354","type":"LOCAL"},{"code":"410379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1975.05,"discounted_cash":1382.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384354 = Hospital System Supply Identifier | 410379 = Lawson ID"}]},{"description":"ROD ORTH TRABCLR OSTNECROSIS","code_information":[{"code":"Sx00-1197-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"1947","type":"LOCAL"},{"code":"339245","type":"LOCAL"}],"standard_charges":[{"gross_charge":10229.26,"discounted_cash":7160.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1947 = 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":"C1776","type":"HCPCS"},{"code":"384799","type":"LOCAL"},{"code":"439191","type":"LOCAL"}],"standard_charges":[{"gross_charge":10229.26,"discounted_cash":7160.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384799 = 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":"384861","type":"LOCAL"},{"code":"454951","type":"LOCAL"}],"standard_charges":[{"gross_charge":10229.26,"discounted_cash":7160.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384861 = Hospital System Supply Identifier | 454951 = 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":"878392","type":"LOCAL"},{"code":"877057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878392 = 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":"878393","type":"LOCAL"},{"code":"877058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878393 = Hospital System Supply Identifier | 877058 = 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":"878391","type":"LOCAL"},{"code":"877056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878391 = Hospital System Supply Identifier | 877056 = 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":"878394","type":"LOCAL"},{"code":"877059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878394 = 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":"878395","type":"LOCAL"},{"code":"877060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878395 = 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":"878396","type":"LOCAL"},{"code":"877061","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878396 = Hospital System Supply Identifier | 877061 = 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":"934511","type":"LOCAL"},{"code":"800253","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934511 = Hospital System Supply Identifier | 800253 = 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":"878397","type":"LOCAL"},{"code":"877062","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878397 = Hospital System Supply Identifier | 877062 = 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":"878398","type":"LOCAL"},{"code":"877063","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878398 = Hospital System Supply Identifier | 877063 = 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":"878405","type":"LOCAL"},{"code":"877070","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878405 = Hospital System Supply Identifier | 877070 = 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":"878404","type":"LOCAL"},{"code":"877069","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878404 = Hospital System Supply Identifier | 877069 = 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":"878406","type":"LOCAL"},{"code":"877071","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878406 = Hospital System Supply Identifier | 877071 = 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":"878403","type":"LOCAL"},{"code":"877068","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878403 = Hospital System Supply Identifier | 877068 = 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":"878399","type":"LOCAL"},{"code":"877064","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878399 = Hospital System Supply Identifier | 877064 = 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":"878401","type":"LOCAL"},{"code":"877066","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878401 = Hospital System Supply Identifier | 877066 = 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":"878400","type":"LOCAL"},{"code":"877065","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878400 = Hospital System Supply Identifier | 877065 = 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":"878402","type":"LOCAL"},{"code":"877067","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878402 = Hospital System Supply Identifier | 877067 = 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":"1176238","type":"LOCAL"},{"code":"1082556","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176238 = 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":"878415","type":"LOCAL"},{"code":"877080","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878415 = 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":"878414","type":"LOCAL"},{"code":"877079","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878414 = 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":"878413","type":"LOCAL"},{"code":"877078","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878413 = 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":"878412","type":"LOCAL"},{"code":"877077","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878412 = 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":"878411","type":"LOCAL"},{"code":"877076","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878411 = Hospital System Supply Identifier | 877076 = 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":"878409","type":"LOCAL"},{"code":"877074","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878409 = 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":"878408","type":"LOCAL"},{"code":"877073","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878408 = 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":"878407","type":"LOCAL"},{"code":"877072","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878407 = Hospital System Supply Identifier | 877072 = Lawson ID"}]},{"description":"PLATE 90DEG 40X6MM","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"636095","type":"LOCAL"},{"code":"711670","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 636095 = Hospital System Supply Identifier | 711670 = 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":"878410","type":"LOCAL"},{"code":"877075","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878410 = Hospital System Supply Identifier | 877075 = 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":"878416","type":"LOCAL"},{"code":"877081","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878416 = Hospital System Supply Identifier | 877081 = 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":"878417","type":"LOCAL"},{"code":"877082","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878417 = Hospital System Supply Identifier | 877082 = 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":"878422","type":"LOCAL"},{"code":"877087","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878422 = Hospital System Supply Identifier | 877087 = 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":"878421","type":"LOCAL"},{"code":"877086","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878421 = Hospital System Supply Identifier | 877086 = 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":"878420","type":"LOCAL"},{"code":"877085","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878420 = Hospital System Supply Identifier | 877085 = 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":"878418","type":"LOCAL"},{"code":"877083","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878418 = Hospital System Supply Identifier | 877083 = 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":"934512","type":"LOCAL"},{"code":"800336","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 934512 = Hospital System Supply Identifier | 800336 = 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":"878419","type":"LOCAL"},{"code":"877084","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878419 = Hospital System Supply Identifier | 877084 = 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":"878423","type":"LOCAL"},{"code":"877088","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878423 = 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":"878424","type":"LOCAL"},{"code":"877089","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878424 = 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":"878425","type":"LOCAL"},{"code":"877090","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878425 = 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":"878426","type":"LOCAL"},{"code":"877091","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878426 = 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":"878427","type":"LOCAL"},{"code":"877092","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878427 = 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":"878428","type":"LOCAL"},{"code":"877093","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878428 = 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":"878429","type":"LOCAL"},{"code":"877094","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878429 = Hospital System Supply Identifier | 877094 = 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":"878435","type":"LOCAL"},{"code":"877100","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878435 = Hospital System Supply Identifier | 877100 = 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":"878430","type":"LOCAL"},{"code":"877095","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878430 = Hospital System Supply Identifier | 877095 = 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":"878431","type":"LOCAL"},{"code":"877096","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878431 = Hospital System Supply Identifier | 877096 = 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":"878432","type":"LOCAL"},{"code":"877097","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878432 = Hospital System Supply Identifier | 877097 = 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":"878433","type":"LOCAL"},{"code":"877098","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878433 = Hospital System Supply Identifier | 877098 = 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":"878434","type":"LOCAL"},{"code":"877099","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878434 = Hospital System Supply Identifier | 877099 = 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":"878436","type":"LOCAL"},{"code":"877101","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878436 = Hospital System Supply Identifier | 877101 = 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":"878438","type":"LOCAL"},{"code":"877103","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878438 = Hospital System Supply Identifier | 877103 = 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":"878437","type":"LOCAL"},{"code":"877102","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878437 = Hospital System Supply Identifier | 877102 = 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":"878439","type":"LOCAL"},{"code":"877104","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878439 = 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":"878444","type":"LOCAL"},{"code":"877109","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878444 = Hospital System Supply Identifier | 877109 = 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":"878443","type":"LOCAL"},{"code":"877108","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878443 = Hospital System Supply Identifier | 877108 = 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":"878442","type":"LOCAL"},{"code":"877107","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878442 = Hospital System Supply Identifier | 877107 = 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":"878441","type":"LOCAL"},{"code":"877106","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878441 = Hospital System Supply Identifier | 877106 = 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":"878440","type":"LOCAL"},{"code":"877105","type":"LOCAL"}],"standard_charges":[{"gross_charge":4816.51,"discounted_cash":3371.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878440 = Hospital System Supply Identifier | 877105 = 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":"1176305","type":"LOCAL"},{"code":"1082448","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176305 = 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":"1175854","type":"LOCAL"},{"code":"1082464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175854 = 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":"1176373","type":"LOCAL"},{"code":"1082483","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176373 = 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":"1176476","type":"LOCAL"},{"code":"1082534","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176476 = 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":"1176010","type":"LOCAL"},{"code":"1082547","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176010 = 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":"1176237","type":"LOCAL"},{"code":"1082571","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176237 = 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":"1176239","type":"LOCAL"},{"code":"1082574","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176239 = Hospital System Supply Identifier | 1082574 = 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":"878452","type":"LOCAL"},{"code":"877117","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878452 = Hospital System Supply Identifier | 877117 = 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":"878451","type":"LOCAL"},{"code":"877116","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878451 = Hospital System Supply Identifier | 877116 = 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":"878450","type":"LOCAL"},{"code":"877115","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878450 = Hospital System Supply Identifier | 877115 = 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":"878449","type":"LOCAL"},{"code":"877114","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878449 = Hospital System Supply Identifier | 877114 = 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":"878445","type":"LOCAL"},{"code":"877110","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878445 = Hospital System Supply Identifier | 877110 = 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":"878447","type":"LOCAL"},{"code":"877112","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878447 = 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":"878446","type":"LOCAL"},{"code":"877111","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878446 = 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":"878448","type":"LOCAL"},{"code":"877113","type":"LOCAL"}],"standard_charges":[{"gross_charge":4941.33,"discounted_cash":3458.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878448 = Hospital System Supply Identifier | 877113 = 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":"878458","type":"LOCAL"},{"code":"877123","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878458 = Hospital System Supply Identifier | 877123 = 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":"878457","type":"LOCAL"},{"code":"877122","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878457 = 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":"878456","type":"LOCAL"},{"code":"877121","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878456 = Hospital System Supply Identifier | 877121 = 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":"878454","type":"LOCAL"},{"code":"877119","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878454 = 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":"878453","type":"LOCAL"},{"code":"877118","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878453 = 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":"878455","type":"LOCAL"},{"code":"877120","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878455 = 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":"878459","type":"LOCAL"},{"code":"877124","type":"LOCAL"}],"standard_charges":[{"gross_charge":5139.2,"discounted_cash":3597.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878459 = 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":"369493","type":"LOCAL"},{"code":"449215","type":"LOCAL"}],"standard_charges":[{"gross_charge":690.95,"discounted_cash":483.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 369493 = 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":"369494","type":"LOCAL"},{"code":"449216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1618.5,"discounted_cash":1132.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 369494 = 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":"369491","type":"LOCAL"},{"code":"449213","type":"LOCAL"}],"standard_charges":[{"gross_charge":327.12,"discounted_cash":228.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 369491 = Hospital System Supply Identifier | 449213 = Lawson ID"}]},{"description":"BIT DRILIL SHANK 6.4X203MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"384774","type":"LOCAL"},{"code":"437851","type":"LOCAL"}],"standard_charges":[{"gross_charge":719.83,"discounted_cash":503.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 384774 = 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":"68702","type":"LOCAL"},{"code":"217910","type":"LOCAL"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68702 = 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":"68703","type":"LOCAL"},{"code":"217911","type":"LOCAL"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 68703 = 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":"878460","type":"LOCAL"},{"code":"877125","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878460 = 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":"878461","type":"LOCAL"},{"code":"877126","type":"LOCAL"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878461 = 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":"878462","type":"LOCAL"},{"code":"877127","type":"LOCAL"}],"standard_charges":[{"gross_charge":217.5,"discounted_cash":152.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878462 = 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":"878463","type":"LOCAL"},{"code":"877128","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.85,"discounted_cash":155.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878463 = 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":"878464","type":"LOCAL"},{"code":"877129","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878464 = 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":"878465","type":"LOCAL"},{"code":"877130","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878465 = 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":"878466","type":"LOCAL"},{"code":"877131","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878466 = 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":"878467","type":"LOCAL"},{"code":"877132","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878467 = 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":"878468","type":"LOCAL"},{"code":"877133","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878468 = 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":"878469","type":"LOCAL"},{"code":"877134","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878469 = 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":"878474","type":"LOCAL"},{"code":"877139","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878474 = 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":"878473","type":"LOCAL"},{"code":"877138","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878473 = Hospital System Supply Identifier | 877138 = 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":"878471","type":"LOCAL"},{"code":"877136","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878471 = Hospital System Supply Identifier | 877136 = 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":"878472","type":"LOCAL"},{"code":"877137","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878472 = Hospital System Supply Identifier | 877137 = 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":"878470","type":"LOCAL"},{"code":"877135","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878470 = 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":"878475","type":"LOCAL"},{"code":"877140","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878475 = 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":"878476","type":"LOCAL"},{"code":"877141","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878476 = 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":"878477","type":"LOCAL"},{"code":"877142","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878477 = 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":"878478","type":"LOCAL"},{"code":"877143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878478 = 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":"878479","type":"LOCAL"},{"code":"877144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878479 = 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":"878480","type":"LOCAL"},{"code":"877145","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878480 = 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":"878485","type":"LOCAL"},{"code":"877150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878485 = Hospital System Supply Identifier | 877150 = 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":"878484","type":"LOCAL"},{"code":"877149","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878484 = 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":"878481","type":"LOCAL"},{"code":"877146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878481 = 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":"878482","type":"LOCAL"},{"code":"877147","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878482 = Hospital System Supply Identifier | 877147 = 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":"878483","type":"LOCAL"},{"code":"877148","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878483 = Hospital System Supply Identifier | 877148 = 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":"878486","type":"LOCAL"},{"code":"877151","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878486 = 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":"878487","type":"LOCAL"},{"code":"877152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878487 = 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":"878488","type":"LOCAL"},{"code":"877153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878488 = Hospital System Supply Identifier | 877153 = 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":"878493","type":"LOCAL"},{"code":"877158","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878493 = Hospital System Supply Identifier | 877158 = 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":"878492","type":"LOCAL"},{"code":"877157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878492 = 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":"878491","type":"LOCAL"},{"code":"877156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878491 = Hospital System Supply Identifier | 877156 = 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":"878490","type":"LOCAL"},{"code":"877155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878490 = Hospital System Supply Identifier | 877155 = 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":"878489","type":"LOCAL"},{"code":"877154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878489 = Hospital System Supply Identifier | 877154 = 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":"878494","type":"LOCAL"},{"code":"877159","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878494 = 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":"878495","type":"LOCAL"},{"code":"877160","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878495 = 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":"878496","type":"LOCAL"},{"code":"877161","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878496 = 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":"878497","type":"LOCAL"},{"code":"877162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878497 = 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":"878498","type":"LOCAL"},{"code":"877163","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878498 = 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":"878499","type":"LOCAL"},{"code":"877164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878499 = 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":"878500","type":"LOCAL"},{"code":"877165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878500 = Hospital System Supply Identifier | 877165 = 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":"878505","type":"LOCAL"},{"code":"877170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878505 = Hospital System Supply Identifier | 877170 = 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":"878504","type":"LOCAL"},{"code":"877169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878504 = Hospital System Supply Identifier | 877169 = 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":"878501","type":"LOCAL"},{"code":"877166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878501 = 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":"878502","type":"LOCAL"},{"code":"877167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878502 = Hospital System Supply Identifier | 877167 = 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":"878503","type":"LOCAL"},{"code":"877168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878503 = Hospital System Supply Identifier | 877168 = 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":"878509","type":"LOCAL"},{"code":"877174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878509 = Hospital System Supply Identifier | 877174 = 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":"878506","type":"LOCAL"},{"code":"877171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878506 = 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":"878507","type":"LOCAL"},{"code":"877172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878507 = 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":"878508","type":"LOCAL"},{"code":"877173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878508 = Hospital System Supply Identifier | 877173 = 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":"878510","type":"LOCAL"},{"code":"877175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878510 = 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":"878511","type":"LOCAL"},{"code":"877176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878511 = 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":"878512","type":"LOCAL"},{"code":"877177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878512 = 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":"878513","type":"LOCAL"},{"code":"877178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878513 = Hospital System Supply Identifier | 877178 = 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":"878514","type":"LOCAL"},{"code":"877179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878514 = Hospital System Supply Identifier | 877179 = 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":"878515","type":"LOCAL"},{"code":"877180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878515 = Hospital System Supply Identifier | 877180 = 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":"878516","type":"LOCAL"},{"code":"877181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878516 = 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":"878517","type":"LOCAL"},{"code":"877182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878517 = 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":"878518","type":"LOCAL"},{"code":"877183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878518 = 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":"878519","type":"LOCAL"},{"code":"877184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878519 = 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":"878520","type":"LOCAL"},{"code":"877185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878520 = Hospital System Supply Identifier | 877185 = 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":"878525","type":"LOCAL"},{"code":"877190","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878525 = Hospital System Supply Identifier | 877190 = 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":"878524","type":"LOCAL"},{"code":"877189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878524 = Hospital System Supply Identifier | 877189 = 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":"878522","type":"LOCAL"},{"code":"877187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878522 = Hospital System Supply Identifier | 877187 = 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":"878521","type":"LOCAL"},{"code":"877186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878521 = Hospital System Supply Identifier | 877186 = 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":"878523","type":"LOCAL"},{"code":"877188","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878523 = Hospital System Supply Identifier | 877188 = 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":"878526","type":"LOCAL"},{"code":"877191","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878526 = 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":"878527","type":"LOCAL"},{"code":"877192","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878527 = 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":"878528","type":"LOCAL"},{"code":"877193","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878528 = Hospital System Supply Identifier | 877193 = 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":"878532","type":"LOCAL"},{"code":"877197","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878532 = Hospital System Supply Identifier | 877197 = 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":"878531","type":"LOCAL"},{"code":"877196","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878531 = Hospital System Supply Identifier | 877196 = 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":"878533","type":"LOCAL"},{"code":"877198","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878533 = Hospital System Supply Identifier | 877198 = 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":"878529","type":"LOCAL"},{"code":"877194","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878529 = 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":"878530","type":"LOCAL"},{"code":"877195","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878530 = Hospital System Supply Identifier | 877195 = 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":"878534","type":"LOCAL"},{"code":"877199","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878534 = 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":"878535","type":"LOCAL"},{"code":"877200","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878535 = Hospital System Supply Identifier | 877200 = 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":"878536","type":"LOCAL"},{"code":"877201","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878536 = Hospital System Supply Identifier | 877201 = 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":"878537","type":"LOCAL"},{"code":"877202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878537 = Hospital System Supply Identifier | 877202 = 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":"878538","type":"LOCAL"},{"code":"877203","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878538 = Hospital System Supply Identifier | 877203 = 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":"878543","type":"LOCAL"},{"code":"877208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878543 = Hospital System Supply Identifier | 877208 = 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":"878541","type":"LOCAL"},{"code":"877206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878541 = 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":"878542","type":"LOCAL"},{"code":"877207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878542 = Hospital System Supply Identifier | 877207 = 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":"878539","type":"LOCAL"},{"code":"877204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878539 = 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":"878540","type":"LOCAL"},{"code":"877205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878540 = Hospital System Supply Identifier | 877205 = 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":"878544","type":"LOCAL"},{"code":"877209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878544 = 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":"878545","type":"LOCAL"},{"code":"877210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878545 = 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":"878546","type":"LOCAL"},{"code":"877211","type":"LOCAL"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878546 = Hospital System Supply Identifier | 877211 = 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":"878547","type":"LOCAL"},{"code":"877212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878547 = Hospital System Supply Identifier | 877212 = 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":"878548","type":"LOCAL"},{"code":"877213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878548 = Hospital System Supply Identifier | 877213 = 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":"878549","type":"LOCAL"},{"code":"877214","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878549 = Hospital System Supply Identifier | 877214 = 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":"878550","type":"LOCAL"},{"code":"877215","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878550 = Hospital System Supply Identifier | 877215 = 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":"878551","type":"LOCAL"},{"code":"877216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878551 = Hospital System Supply Identifier | 877216 = 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":"878556","type":"LOCAL"},{"code":"877221","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878556 = Hospital System Supply Identifier | 877221 = 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":"878554","type":"LOCAL"},{"code":"877219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878554 = 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":"878555","type":"LOCAL"},{"code":"877220","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878555 = Hospital System Supply Identifier | 877220 = 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":"878553","type":"LOCAL"},{"code":"877218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878553 = Hospital System Supply Identifier | 877218 = 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":"878552","type":"LOCAL"},{"code":"877217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878552 = Hospital System Supply Identifier | 877217 = 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":"878557","type":"LOCAL"},{"code":"877222","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878557 = Hospital System Supply Identifier | 877222 = 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":"878558","type":"LOCAL"},{"code":"877223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878558 = Hospital System Supply Identifier | 877223 = 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":"878559","type":"LOCAL"},{"code":"877224","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878559 = Hospital System Supply Identifier | 877224 = 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":"878560","type":"LOCAL"},{"code":"877225","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878560 = Hospital System Supply Identifier | 877225 = 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":"878561","type":"LOCAL"},{"code":"877226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878561 = Hospital System Supply Identifier | 877226 = 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":"878566","type":"LOCAL"},{"code":"877231","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878566 = Hospital System Supply Identifier | 877231 = 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":"878565","type":"LOCAL"},{"code":"877230","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878565 = Hospital System Supply Identifier | 877230 = 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":"878564","type":"LOCAL"},{"code":"877229","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878564 = Hospital System Supply Identifier | 877229 = 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":"878563","type":"LOCAL"},{"code":"877228","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878563 = Hospital System Supply Identifier | 877228 = 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":"878562","type":"LOCAL"},{"code":"877227","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878562 = Hospital System Supply Identifier | 877227 = 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":"878567","type":"LOCAL"},{"code":"877232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878567 = 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":"878568","type":"LOCAL"},{"code":"877233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878568 = 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":"878569","type":"LOCAL"},{"code":"877234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878569 = 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":"878570","type":"LOCAL"},{"code":"877235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878570 = 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":"878571","type":"LOCAL"},{"code":"877236","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878571 = Hospital System Supply Identifier | 877236 = 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":"878576","type":"LOCAL"},{"code":"877241","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878576 = Hospital System Supply Identifier | 877241 = 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":"878575","type":"LOCAL"},{"code":"877240","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878575 = Hospital System Supply Identifier | 877240 = 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":"878574","type":"LOCAL"},{"code":"877239","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878574 = Hospital System Supply Identifier | 877239 = 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":"878573","type":"LOCAL"},{"code":"877238","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878573 = Hospital System Supply Identifier | 877238 = 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":"878572","type":"LOCAL"},{"code":"877237","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878572 = Hospital System Supply Identifier | 877237 = 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":"878577","type":"LOCAL"},{"code":"877242","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878577 = Hospital System Supply Identifier | 877242 = 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":"878578","type":"LOCAL"},{"code":"877243","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878578 = Hospital System Supply Identifier | 877243 = 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":"878579","type":"LOCAL"},{"code":"877244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878579 = Hospital System Supply Identifier | 877244 = 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":"878580","type":"LOCAL"},{"code":"877245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878580 = Hospital System Supply Identifier | 877245 = 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":"878581","type":"LOCAL"},{"code":"877246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878581 = Hospital System Supply Identifier | 877246 = 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":"878586","type":"LOCAL"},{"code":"877251","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878586 = Hospital System Supply Identifier | 877251 = 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":"878585","type":"LOCAL"},{"code":"877250","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878585 = Hospital System Supply Identifier | 877250 = 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":"878584","type":"LOCAL"},{"code":"877249","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878584 = Hospital System Supply Identifier | 877249 = 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":"878583","type":"LOCAL"},{"code":"877248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878583 = Hospital System Supply Identifier | 877248 = 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":"878582","type":"LOCAL"},{"code":"877247","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878582 = Hospital System Supply Identifier | 877247 = 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":"878587","type":"LOCAL"},{"code":"877252","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878587 = 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":"878588","type":"LOCAL"},{"code":"877253","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878588 = 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":"878589","type":"LOCAL"},{"code":"877254","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878589 = 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":"878590","type":"LOCAL"},{"code":"877255","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878590 = 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":"878591","type":"LOCAL"},{"code":"877256","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878591 = 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":"878592","type":"LOCAL"},{"code":"877257","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878592 = 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":"878593","type":"LOCAL"},{"code":"877258","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878593 = 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":"878594","type":"LOCAL"},{"code":"877259","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878594 = 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":"878598","type":"LOCAL"},{"code":"877263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878598 = 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":"878597","type":"LOCAL"},{"code":"877262","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878597 = 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":"878599","type":"LOCAL"},{"code":"877264","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878599 = 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":"878595","type":"LOCAL"},{"code":"877260","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878595 = 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":"878596","type":"LOCAL"},{"code":"877261","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878596 = 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":"878600","type":"LOCAL"},{"code":"877265","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878600 = 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":"878601","type":"LOCAL"},{"code":"877266","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878601 = 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":"878602","type":"LOCAL"},{"code":"877267","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878602 = 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":"878603","type":"LOCAL"},{"code":"877268","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878603 = 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":"878604","type":"LOCAL"},{"code":"877269","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878604 = 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":"878608","type":"LOCAL"},{"code":"877273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878608 = Hospital System Supply Identifier | 877273 = 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":"878607","type":"LOCAL"},{"code":"877272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878607 = 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":"878609","type":"LOCAL"},{"code":"877274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878609 = Hospital System Supply Identifier | 877274 = 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":"878605","type":"LOCAL"},{"code":"877270","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878605 = 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":"878606","type":"LOCAL"},{"code":"877271","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878606 = Hospital System Supply Identifier | 877271 = 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":"878610","type":"LOCAL"},{"code":"877275","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878610 = Hospital System Supply Identifier | 877275 = 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":"878611","type":"LOCAL"},{"code":"877276","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878611 = Hospital System Supply Identifier | 877276 = 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":"878612","type":"LOCAL"},{"code":"877277","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878612 = 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":"878613","type":"LOCAL"},{"code":"877278","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878613 = 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":"878614","type":"LOCAL"},{"code":"877279","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878614 = 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":"878615","type":"LOCAL"},{"code":"877280","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878615 = 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":"878616","type":"LOCAL"},{"code":"877281","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878616 = 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":"878617","type":"LOCAL"},{"code":"877282","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878617 = 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":"878622","type":"LOCAL"},{"code":"877287","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878622 = 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":"878621","type":"LOCAL"},{"code":"877286","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878621 = Hospital System Supply Identifier | 877286 = 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":"878619","type":"LOCAL"},{"code":"877284","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878619 = 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":"878618","type":"LOCAL"},{"code":"877283","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878618 = Hospital System Supply Identifier | 877283 = 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":"878620","type":"LOCAL"},{"code":"877285","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878620 = Hospital System Supply Identifier | 877285 = 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":"878623","type":"LOCAL"},{"code":"877288","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878623 = 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":"878624","type":"LOCAL"},{"code":"877289","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878624 = 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":"878625","type":"LOCAL"},{"code":"877290","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878625 = 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":"878626","type":"LOCAL"},{"code":"877291","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878626 = 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":"878627","type":"LOCAL"},{"code":"877292","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878627 = Hospital System Supply Identifier | 877292 = 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":"878630","type":"LOCAL"},{"code":"877295","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878630 = Hospital System Supply Identifier | 877295 = 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":"878632","type":"LOCAL"},{"code":"877297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878632 = 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":"878631","type":"LOCAL"},{"code":"877296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878631 = Hospital System Supply Identifier | 877296 = 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":"878629","type":"LOCAL"},{"code":"877294","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878629 = 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":"878628","type":"LOCAL"},{"code":"877293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878628 = 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":"878633","type":"LOCAL"},{"code":"877298","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878633 = 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":"878634","type":"LOCAL"},{"code":"877299","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878634 = 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":"878635","type":"LOCAL"},{"code":"877300","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878635 = 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":"878636","type":"LOCAL"},{"code":"877301","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878636 = 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":"878637","type":"LOCAL"},{"code":"877302","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878637 = 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":"878638","type":"LOCAL"},{"code":"877303","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878638 = 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":"878639","type":"LOCAL"},{"code":"877304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878639 = 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":"878640","type":"LOCAL"},{"code":"877305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878640 = 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":"878641","type":"LOCAL"},{"code":"877306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878641 = 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":"878642","type":"LOCAL"},{"code":"877307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878642 = 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":"878643","type":"LOCAL"},{"code":"877308","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878643 = 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":"878644","type":"LOCAL"},{"code":"877309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878644 = 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":"878645","type":"LOCAL"},{"code":"877310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878645 = 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":"878646","type":"LOCAL"},{"code":"877311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878646 = 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":"878647","type":"LOCAL"},{"code":"877312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878647 = 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":"878652","type":"LOCAL"},{"code":"877317","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878652 = Hospital System Supply Identifier | 877317 = 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":"878651","type":"LOCAL"},{"code":"877316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878651 = Hospital System Supply Identifier | 877316 = 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":"878650","type":"LOCAL"},{"code":"877315","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878650 = Hospital System Supply Identifier | 877315 = 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":"878649","type":"LOCAL"},{"code":"877314","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878649 = Hospital System Supply Identifier | 877314 = 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":"878648","type":"LOCAL"},{"code":"877313","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878648 = Hospital System Supply Identifier | 877313 = 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":"878653","type":"LOCAL"},{"code":"877318","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878653 = 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":"878654","type":"LOCAL"},{"code":"877319","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878654 = 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":"878655","type":"LOCAL"},{"code":"877320","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878655 = 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":"878656","type":"LOCAL"},{"code":"877321","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878656 = 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":"878657","type":"LOCAL"},{"code":"877322","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878657 = Hospital System Supply Identifier | 877322 = 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":"878662","type":"LOCAL"},{"code":"877327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878662 = Hospital System Supply Identifier | 877327 = 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":"878660","type":"LOCAL"},{"code":"877325","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878660 = Hospital System Supply Identifier | 877325 = 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":"878661","type":"LOCAL"},{"code":"877326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878661 = Hospital System Supply Identifier | 877326 = 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":"878658","type":"LOCAL"},{"code":"877323","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878658 = Hospital System Supply Identifier | 877323 = 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":"878659","type":"LOCAL"},{"code":"877324","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878659 = Hospital System Supply Identifier | 877324 = 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":"878663","type":"LOCAL"},{"code":"877328","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878663 = 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":"878664","type":"LOCAL"},{"code":"877329","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878664 = 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":"878665","type":"LOCAL"},{"code":"877330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878665 = Hospital System Supply Identifier | 877330 = 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":"878669","type":"LOCAL"},{"code":"877334","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878669 = 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":"1176649","type":"LOCAL"},{"code":"1083674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176649 = 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":"878666","type":"LOCAL"},{"code":"877331","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878666 = Hospital System Supply Identifier | 877331 = 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":"878667","type":"LOCAL"},{"code":"877332","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878667 = Hospital System Supply Identifier | 877332 = 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":"878668","type":"LOCAL"},{"code":"877333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878668 = Hospital System Supply Identifier | 877333 = 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":"878674","type":"LOCAL"},{"code":"877339","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878674 = 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":"878673","type":"LOCAL"},{"code":"877338","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878673 = 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":"878670","type":"LOCAL"},{"code":"877335","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878670 = 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":"878671","type":"LOCAL"},{"code":"877336","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878671 = 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":"878672","type":"LOCAL"},{"code":"877337","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878672 = Hospital System Supply Identifier | 877337 = 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":"878678","type":"LOCAL"},{"code":"877343","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878678 = Hospital System Supply Identifier | 877343 = 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":"878675","type":"LOCAL"},{"code":"877340","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878675 = 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":"878676","type":"LOCAL"},{"code":"877341","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878676 = 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":"878677","type":"LOCAL"},{"code":"877342","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878677 = Hospital System Supply Identifier | 877342 = 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":"878679","type":"LOCAL"},{"code":"877344","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878679 = Hospital System Supply Identifier | 877344 = 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":"878683","type":"LOCAL"},{"code":"877348","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878683 = Hospital System Supply Identifier | 877348 = 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":"878684","type":"LOCAL"},{"code":"877349","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878684 = Hospital System Supply Identifier | 877349 = 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":"878682","type":"LOCAL"},{"code":"877347","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878682 = Hospital System Supply Identifier | 877347 = 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":"878680","type":"LOCAL"},{"code":"877345","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878680 = Hospital System Supply Identifier | 877345 = 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":"878681","type":"LOCAL"},{"code":"877346","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878681 = Hospital System Supply Identifier | 877346 = 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":"878685","type":"LOCAL"},{"code":"877350","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878685 = 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":"878686","type":"LOCAL"},{"code":"877351","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878686 = 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":"878687","type":"LOCAL"},{"code":"877352","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878687 = Hospital System Supply Identifier | 877352 = 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":"878688","type":"LOCAL"},{"code":"877353","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878688 = Hospital System Supply Identifier | 877353 = 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":"878689","type":"LOCAL"},{"code":"877354","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878689 = 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":"878690","type":"LOCAL"},{"code":"877355","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878690 = 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":"878691","type":"LOCAL"},{"code":"877356","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878691 = 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":"878692","type":"LOCAL"},{"code":"877357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878692 = Hospital System Supply Identifier | 877357 = 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":"878695","type":"LOCAL"},{"code":"877360","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878695 = 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":"878693","type":"LOCAL"},{"code":"877358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878693 = Hospital System Supply Identifier | 877358 = 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":"878694","type":"LOCAL"},{"code":"877359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878694 = Hospital System Supply Identifier | 877359 = 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":"878700","type":"LOCAL"},{"code":"877365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878700 = Hospital System Supply Identifier | 877365 = 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":"878696","type":"LOCAL"},{"code":"877361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878696 = 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":"878697","type":"LOCAL"},{"code":"877362","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878697 = 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":"878698","type":"LOCAL"},{"code":"877363","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878698 = 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":"878699","type":"LOCAL"},{"code":"877364","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878699 = Hospital System Supply Identifier | 877364 = 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":"878703","type":"LOCAL"},{"code":"877368","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878703 = Hospital System Supply Identifier | 877368 = 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":"878705","type":"LOCAL"},{"code":"877370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878705 = Hospital System Supply Identifier | 877370 = 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":"878701","type":"LOCAL"},{"code":"877366","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878701 = Hospital System Supply Identifier | 877366 = 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":"878702","type":"LOCAL"},{"code":"877367","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878702 = Hospital System Supply Identifier | 877367 = 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":"878704","type":"LOCAL"},{"code":"877369","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878704 = Hospital System Supply Identifier | 877369 = 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":"878706","type":"LOCAL"},{"code":"877371","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878706 = 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":"878707","type":"LOCAL"},{"code":"877372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878707 = 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":"878708","type":"LOCAL"},{"code":"877373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878708 = 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":"878709","type":"LOCAL"},{"code":"877374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878709 = 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":"878710","type":"LOCAL"},{"code":"877375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878710 = Hospital System Supply Identifier | 877375 = 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":"878713","type":"LOCAL"},{"code":"877378","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878713 = 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":"878715","type":"LOCAL"},{"code":"877380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878715 = 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":"878711","type":"LOCAL"},{"code":"877376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878711 = 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":"878712","type":"LOCAL"},{"code":"877377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878712 = Hospital System Supply Identifier | 877377 = 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":"878714","type":"LOCAL"},{"code":"877379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878714 = Hospital System Supply Identifier | 877379 = 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":"878716","type":"LOCAL"},{"code":"877381","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878716 = 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":"878717","type":"LOCAL"},{"code":"877382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878717 = 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":"878718","type":"LOCAL"},{"code":"877383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878718 = 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":"878719","type":"LOCAL"},{"code":"877384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878719 = 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":"878720","type":"LOCAL"},{"code":"877385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878720 = 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":"878721","type":"LOCAL"},{"code":"877386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878721 = 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":"878722","type":"LOCAL"},{"code":"877387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878722 = 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":"878723","type":"LOCAL"},{"code":"877388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878723 = Hospital System Supply Identifier | 877388 = 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":"878728","type":"LOCAL"},{"code":"877392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878728 = Hospital System Supply Identifier | 877392 = 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":"878729","type":"LOCAL"},{"code":"877393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878729 = Hospital System Supply Identifier | 877393 = 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":"878726","type":"LOCAL"},{"code":"877390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878726 = Hospital System Supply Identifier | 877390 = 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":"878724","type":"LOCAL"},{"code":"877389","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878724 = Hospital System Supply Identifier | 877389 = 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":"878727","type":"LOCAL"},{"code":"877391","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878727 = 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":"878730","type":"LOCAL"},{"code":"877394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878730 = 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":"878731","type":"LOCAL"},{"code":"877395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878731 = 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":"878732","type":"LOCAL"},{"code":"877396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878732 = 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":"878733","type":"LOCAL"},{"code":"877397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878733 = 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":"878734","type":"LOCAL"},{"code":"877398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878734 = Hospital System Supply Identifier | 877398 = 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":"878737","type":"LOCAL"},{"code":"877401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878737 = Hospital System Supply Identifier | 877401 = 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":"878739","type":"LOCAL"},{"code":"877403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878739 = Hospital System Supply Identifier | 877403 = 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":"878735","type":"LOCAL"},{"code":"877399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878735 = Hospital System Supply Identifier | 877399 = 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":"878736","type":"LOCAL"},{"code":"877400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878736 = Hospital System Supply Identifier | 877400 = 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":"878738","type":"LOCAL"},{"code":"877402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878738 = Hospital System Supply Identifier | 877402 = 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":"878740","type":"LOCAL"},{"code":"877404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878740 = 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":"878741","type":"LOCAL"},{"code":"877405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878741 = 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":"878742","type":"LOCAL"},{"code":"877406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878742 = 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":"878743","type":"LOCAL"},{"code":"877407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878743 = 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":"878744","type":"LOCAL"},{"code":"877408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878744 = 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":"878745","type":"LOCAL"},{"code":"877409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878745 = 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":"878746","type":"LOCAL"},{"code":"877410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878746 = Hospital System Supply Identifier | 877410 = 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":"878750","type":"LOCAL"},{"code":"877414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878750 = Hospital System Supply Identifier | 877414 = 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":"878751","type":"LOCAL"},{"code":"877415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878751 = Hospital System Supply Identifier | 877415 = 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":"878748","type":"LOCAL"},{"code":"877412","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878748 = 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":"878747","type":"LOCAL"},{"code":"877411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878747 = 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":"878749","type":"LOCAL"},{"code":"877413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878749 = 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":"878752","type":"LOCAL"},{"code":"877416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878752 = 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":"878753","type":"LOCAL"},{"code":"877417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878753 = 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":"878754","type":"LOCAL"},{"code":"877418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878754 = 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":"878755","type":"LOCAL"},{"code":"877419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878755 = 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":"878756","type":"LOCAL"},{"code":"877420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878756 = 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":"878761","type":"LOCAL"},{"code":"877425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878761 = 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":"878760","type":"LOCAL"},{"code":"877424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878760 = Hospital System Supply Identifier | 877424 = 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":"878759","type":"LOCAL"},{"code":"877423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878759 = Hospital System Supply Identifier | 877423 = 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":"878757","type":"LOCAL"},{"code":"877421","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878757 = Hospital System Supply Identifier | 877421 = 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":"878758","type":"LOCAL"},{"code":"877422","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878758 = Hospital System Supply Identifier | 877422 = 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":"878762","type":"LOCAL"},{"code":"877426","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878762 = 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":"878763","type":"LOCAL"},{"code":"877427","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878763 = 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":"878764","type":"LOCAL"},{"code":"877428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878764 = 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":"878765","type":"LOCAL"},{"code":"877429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878765 = 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":"878766","type":"LOCAL"},{"code":"877430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878766 = Hospital System Supply Identifier | 877430 = 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":"878767","type":"LOCAL"},{"code":"877431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878767 = Hospital System Supply Identifier | 877431 = 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":"878768","type":"LOCAL"},{"code":"877432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878768 = Hospital System Supply Identifier | 877432 = 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":"878770","type":"LOCAL"},{"code":"877434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878770 = 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":"878769","type":"LOCAL"},{"code":"877433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878769 = 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":"878771","type":"LOCAL"},{"code":"877435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878771 = 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":"878772","type":"LOCAL"},{"code":"877436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878772 = 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":"878773","type":"LOCAL"},{"code":"877437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878773 = 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":"878774","type":"LOCAL"},{"code":"877438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878774 = 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":"878775","type":"LOCAL"},{"code":"877439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878775 = 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":"878776","type":"LOCAL"},{"code":"877440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878776 = 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":"878781","type":"LOCAL"},{"code":"877445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878781 = Hospital System Supply Identifier | 877445 = 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":"878779","type":"LOCAL"},{"code":"877443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878779 = Hospital System Supply Identifier | 877443 = 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":"878780","type":"LOCAL"},{"code":"877444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878780 = Hospital System Supply Identifier | 877444 = 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":"878777","type":"LOCAL"},{"code":"877441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878777 = Hospital System Supply Identifier | 877441 = 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":"878778","type":"LOCAL"},{"code":"877442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878778 = Hospital System Supply Identifier | 877442 = 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":"878782","type":"LOCAL"},{"code":"877446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878782 = 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":"878783","type":"LOCAL"},{"code":"877447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878783 = 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":"878784","type":"LOCAL"},{"code":"877448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878784 = 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":"878785","type":"LOCAL"},{"code":"877449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878785 = 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":"878786","type":"LOCAL"},{"code":"877450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878786 = 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":"878787","type":"LOCAL"},{"code":"877451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878787 = 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":"878788","type":"LOCAL"},{"code":"877452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878788 = 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":"878790","type":"LOCAL"},{"code":"877454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878790 = 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":"878789","type":"LOCAL"},{"code":"877453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878789 = Hospital System Supply Identifier | 877453 = 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":"878792","type":"LOCAL"},{"code":"877456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878792 = Hospital System Supply Identifier | 877456 = 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":"878791","type":"LOCAL"},{"code":"877455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878791 = Hospital System Supply Identifier | 877455 = 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":"878793","type":"LOCAL"},{"code":"877457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878793 = 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":"878794","type":"LOCAL"},{"code":"877458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878794 = 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":"878795","type":"LOCAL"},{"code":"877459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878795 = 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":"878796","type":"LOCAL"},{"code":"877460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878796 = 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":"878797","type":"LOCAL"},{"code":"877461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878797 = Hospital System Supply Identifier | 877461 = 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":"878798","type":"LOCAL"},{"code":"877462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878798 = Hospital System Supply Identifier | 877462 = 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":"878799","type":"LOCAL"},{"code":"877463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878799 = Hospital System Supply Identifier | 877463 = 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":"878800","type":"LOCAL"},{"code":"877464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878800 = Hospital System Supply Identifier | 877464 = 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":"878801","type":"LOCAL"},{"code":"877465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878801 = 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":"878802","type":"LOCAL"},{"code":"877466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878802 = Hospital System Supply Identifier | 877466 = 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":"878804","type":"LOCAL"},{"code":"877468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878804 = Hospital System Supply Identifier | 877468 = 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":"878803","type":"LOCAL"},{"code":"877467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878803 = Hospital System Supply Identifier | 877467 = 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":"878805","type":"LOCAL"},{"code":"877469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878805 = 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":"878806","type":"LOCAL"},{"code":"877470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878806 = 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":"878807","type":"LOCAL"},{"code":"877471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878807 = 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":"878808","type":"LOCAL"},{"code":"877472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878808 = Hospital System Supply Identifier | 877472 = 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":"878809","type":"LOCAL"},{"code":"877473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878809 = Hospital System Supply Identifier | 877473 = 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":"878810","type":"LOCAL"},{"code":"877474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878810 = Hospital System Supply Identifier | 877474 = 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":"878811","type":"LOCAL"},{"code":"877475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878811 = Hospital System Supply Identifier | 877475 = 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":"878816","type":"LOCAL"},{"code":"877480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878816 = Hospital System Supply Identifier | 877480 = 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":"878815","type":"LOCAL"},{"code":"877479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878815 = Hospital System Supply Identifier | 877479 = 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":"878812","type":"LOCAL"},{"code":"877476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878812 = 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":"878813","type":"LOCAL"},{"code":"877477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878813 = 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":"878814","type":"LOCAL"},{"code":"877478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878814 = Hospital System Supply Identifier | 877478 = 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":"878817","type":"LOCAL"},{"code":"877481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878817 = Hospital System Supply Identifier | 877481 = 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":"878818","type":"LOCAL"},{"code":"877482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878818 = Hospital System Supply Identifier | 877482 = 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":"878819","type":"LOCAL"},{"code":"877483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878819 = Hospital System Supply Identifier | 877483 = 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":"878820","type":"LOCAL"},{"code":"877484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878820 = Hospital System Supply Identifier | 877484 = 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":"878821","type":"LOCAL"},{"code":"877485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878821 = Hospital System Supply Identifier | 877485 = 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":"878824","type":"LOCAL"},{"code":"877488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878824 = Hospital System Supply Identifier | 877488 = 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":"878826","type":"LOCAL"},{"code":"877490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878826 = Hospital System Supply Identifier | 877490 = 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":"878822","type":"LOCAL"},{"code":"877486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878822 = 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":"878823","type":"LOCAL"},{"code":"877487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878823 = Hospital System Supply Identifier | 877487 = 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":"878825","type":"LOCAL"},{"code":"877489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878825 = Hospital System Supply Identifier | 877489 = 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":"878827","type":"LOCAL"},{"code":"877491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878827 = 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":"878828","type":"LOCAL"},{"code":"877492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878828 = Hospital System Supply Identifier | 877492 = 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":"878829","type":"LOCAL"},{"code":"877493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878829 = Hospital System Supply Identifier | 877493 = 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":"878830","type":"LOCAL"},{"code":"877494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878830 = Hospital System Supply Identifier | 877494 = 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":"878831","type":"LOCAL"},{"code":"877495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878831 = 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":"878832","type":"LOCAL"},{"code":"877496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878832 = Hospital System Supply Identifier | 877496 = 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":"878834","type":"LOCAL"},{"code":"877498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878834 = Hospital System Supply Identifier | 877498 = 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":"878833","type":"LOCAL"},{"code":"877497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878833 = Hospital System Supply Identifier | 877497 = 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":"878836","type":"LOCAL"},{"code":"877500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878836 = Hospital System Supply Identifier | 877500 = 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":"878835","type":"LOCAL"},{"code":"877499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878835 = Hospital System Supply Identifier | 877499 = 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":"878837","type":"LOCAL"},{"code":"877501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878837 = 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":"878838","type":"LOCAL"},{"code":"877502","type":"LOCAL"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878838 = Hospital System Supply Identifier | 877502 = 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":"878839","type":"LOCAL"},{"code":"877503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878839 = Hospital System Supply Identifier | 877503 = 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":"878840","type":"LOCAL"},{"code":"877504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878840 = Hospital System Supply Identifier | 877504 = 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":"878841","type":"LOCAL"},{"code":"877505","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878841 = 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":"878842","type":"LOCAL"},{"code":"877506","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878842 = 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":"878843","type":"LOCAL"},{"code":"877507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878843 = 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":"878844","type":"LOCAL"},{"code":"877508","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878844 = Hospital System Supply Identifier | 877508 = 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":"878847","type":"LOCAL"},{"code":"877510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878847 = Hospital System Supply Identifier | 877510 = 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":"878846","type":"LOCAL"},{"code":"877509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878846 = Hospital System Supply Identifier | 877509 = 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":"878848","type":"LOCAL"},{"code":"877511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878848 = 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":"878849","type":"LOCAL"},{"code":"877512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878849 = Hospital System Supply Identifier | 877512 = 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":"878850","type":"LOCAL"},{"code":"877513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878850 = Hospital System Supply Identifier | 877513 = 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":"878851","type":"LOCAL"},{"code":"877514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878851 = Hospital System Supply Identifier | 877514 = 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":"878852","type":"LOCAL"},{"code":"877515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878852 = 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":"878854","type":"LOCAL"},{"code":"877516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878854 = Hospital System Supply Identifier | 877516 = 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":"878856","type":"LOCAL"},{"code":"877518","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878856 = Hospital System Supply Identifier | 877518 = 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":"878855","type":"LOCAL"},{"code":"877517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878855 = Hospital System Supply Identifier | 877517 = 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":"878858","type":"LOCAL"},{"code":"877520","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878858 = Hospital System Supply Identifier | 877520 = 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":"878857","type":"LOCAL"},{"code":"877519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878857 = Hospital System Supply Identifier | 877519 = 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":"878859","type":"LOCAL"},{"code":"877521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878859 = Hospital System Supply Identifier | 877521 = 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":"878860","type":"LOCAL"},{"code":"877522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878860 = Hospital System Supply Identifier | 877522 = 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":"878861","type":"LOCAL"},{"code":"877523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878861 = Hospital System Supply Identifier | 877523 = 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":"878862","type":"LOCAL"},{"code":"877524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878862 = Hospital System Supply Identifier | 877524 = 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":"878863","type":"LOCAL"},{"code":"877525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878863 = Hospital System Supply Identifier | 877525 = 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":"878864","type":"LOCAL"},{"code":"877526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878864 = Hospital System Supply Identifier | 877526 = 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":"878865","type":"LOCAL"},{"code":"877527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878865 = Hospital System Supply Identifier | 877527 = 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":"878866","type":"LOCAL"},{"code":"877528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878866 = Hospital System Supply Identifier | 877528 = 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":"878871","type":"LOCAL"},{"code":"877533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878871 = Hospital System Supply Identifier | 877533 = 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":"878870","type":"LOCAL"},{"code":"877532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878870 = Hospital System Supply Identifier | 877532 = 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":"878868","type":"LOCAL"},{"code":"877530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878868 = Hospital System Supply Identifier | 877530 = 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":"878867","type":"LOCAL"},{"code":"877529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878867 = Hospital System Supply Identifier | 877529 = 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":"878869","type":"LOCAL"},{"code":"877531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878869 = Hospital System Supply Identifier | 877531 = 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":"878872","type":"LOCAL"},{"code":"877534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878872 = Hospital System Supply Identifier | 877534 = 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":"878873","type":"LOCAL"},{"code":"877535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878873 = Hospital System Supply Identifier | 877535 = 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":"878874","type":"LOCAL"},{"code":"877536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878874 = Hospital System Supply Identifier | 877536 = 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":"878875","type":"LOCAL"},{"code":"877537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878875 = Hospital System Supply Identifier | 877537 = 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":"878876","type":"LOCAL"},{"code":"877538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878876 = Hospital System Supply Identifier | 877538 = 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":"878881","type":"LOCAL"},{"code":"877543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878881 = Hospital System Supply Identifier | 877543 = 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":"878880","type":"LOCAL"},{"code":"877542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878880 = Hospital System Supply Identifier | 877542 = 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":"878878","type":"LOCAL"},{"code":"877540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878878 = Hospital System Supply Identifier | 877540 = 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":"878877","type":"LOCAL"},{"code":"877539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878877 = Hospital System Supply Identifier | 877539 = 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":"878879","type":"LOCAL"},{"code":"877541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878879 = Hospital System Supply Identifier | 877541 = 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":"878882","type":"LOCAL"},{"code":"877544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878882 = Hospital System Supply Identifier | 877544 = 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":"878883","type":"LOCAL"},{"code":"877545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878883 = Hospital System Supply Identifier | 877545 = 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":"878884","type":"LOCAL"},{"code":"877546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878884 = Hospital System Supply Identifier | 877546 = 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":"878885","type":"LOCAL"},{"code":"877547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878885 = Hospital System Supply Identifier | 877547 = 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":"878886","type":"LOCAL"},{"code":"877548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878886 = Hospital System Supply Identifier | 877548 = 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":"878889","type":"LOCAL"},{"code":"877551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878889 = Hospital System Supply Identifier | 877551 = 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":"878887","type":"LOCAL"},{"code":"877549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878887 = 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":"878888","type":"LOCAL"},{"code":"877550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878888 = Hospital System Supply Identifier | 877550 = 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":"878890","type":"LOCAL"},{"code":"877552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878890 = 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":"878891","type":"LOCAL"},{"code":"877553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878891 = 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":"878892","type":"LOCAL"},{"code":"877554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878892 = 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":"878893","type":"LOCAL"},{"code":"877555","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878893 = Hospital System Supply Identifier | 877555 = 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":"878894","type":"LOCAL"},{"code":"877556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878894 = Hospital System Supply Identifier | 877556 = 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":"878895","type":"LOCAL"},{"code":"877557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878895 = Hospital System Supply Identifier | 877557 = 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":"878897","type":"LOCAL"},{"code":"877559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878897 = Hospital System Supply Identifier | 877559 = 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":"878896","type":"LOCAL"},{"code":"877558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878896 = Hospital System Supply Identifier | 877558 = 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":"878899","type":"LOCAL"},{"code":"877561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878899 = Hospital System Supply Identifier | 877561 = 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":"878898","type":"LOCAL"},{"code":"877560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878898 = Hospital System Supply Identifier | 877560 = 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":"878900","type":"LOCAL"},{"code":"877562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878900 = 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":"878901","type":"LOCAL"},{"code":"877563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878901 = 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":"878902","type":"LOCAL"},{"code":"877564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878902 = 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":"878903","type":"LOCAL"},{"code":"877565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878903 = 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":"878904","type":"LOCAL"},{"code":"877566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878904 = Hospital System Supply Identifier | 877566 = 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":"878905","type":"LOCAL"},{"code":"877567","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878905 = Hospital System Supply Identifier | 877567 = 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":"878906","type":"LOCAL"},{"code":"877568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878906 = Hospital System Supply Identifier | 877568 = 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":"878907","type":"LOCAL"},{"code":"877569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878907 = 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":"878908","type":"LOCAL"},{"code":"877570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878908 = Hospital System Supply Identifier | 877570 = 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":"878910","type":"LOCAL"},{"code":"877572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878910 = Hospital System Supply Identifier | 877572 = 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":"878909","type":"LOCAL"},{"code":"877571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878909 = Hospital System Supply Identifier | 877571 = 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":"878911","type":"LOCAL"},{"code":"877573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878911 = 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":"878912","type":"LOCAL"},{"code":"877574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878912 = Hospital System Supply Identifier | 877574 = 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":"878913","type":"LOCAL"},{"code":"877575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878913 = Hospital System Supply Identifier | 877575 = 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":"878914","type":"LOCAL"},{"code":"877576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878914 = Hospital System Supply Identifier | 877576 = 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":"878915","type":"LOCAL"},{"code":"877577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878915 = 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":"878916","type":"LOCAL"},{"code":"877578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878916 = Hospital System Supply Identifier | 877578 = 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":"878917","type":"LOCAL"},{"code":"877579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878917 = Hospital System Supply Identifier | 877579 = 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":"878918","type":"LOCAL"},{"code":"877580","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878918 = Hospital System Supply Identifier | 877580 = 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":"878920","type":"LOCAL"},{"code":"877582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878920 = Hospital System Supply Identifier | 877582 = 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":"878919","type":"LOCAL"},{"code":"877581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878919 = Hospital System Supply Identifier | 877581 = 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":"878921","type":"LOCAL"},{"code":"877583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878921 = Hospital System Supply Identifier | 877583 = 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":"878922","type":"LOCAL"},{"code":"877584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878922 = 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":"878923","type":"LOCAL"},{"code":"877585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878923 = Hospital System Supply Identifier | 877585 = 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":"878924","type":"LOCAL"},{"code":"877586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878924 = Hospital System Supply Identifier | 877586 = 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":"878925","type":"LOCAL"},{"code":"877587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878925 = Hospital System Supply Identifier | 877587 = 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":"878926","type":"LOCAL"},{"code":"877588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878926 = Hospital System Supply Identifier | 877588 = 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":"878931","type":"LOCAL"},{"code":"877593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878931 = 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":"878930","type":"LOCAL"},{"code":"877592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878930 = Hospital System Supply Identifier | 877592 = 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":"878929","type":"LOCAL"},{"code":"877591","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878929 = Hospital System Supply Identifier | 877591 = 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":"878928","type":"LOCAL"},{"code":"877590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878928 = Hospital System Supply Identifier | 877590 = 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":"878927","type":"LOCAL"},{"code":"877589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878927 = Hospital System Supply Identifier | 877589 = 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":"878932","type":"LOCAL"},{"code":"877594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878932 = 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":"878933","type":"LOCAL"},{"code":"877595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878933 = 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":"878934","type":"LOCAL"},{"code":"877596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878934 = 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":"878935","type":"LOCAL"},{"code":"877597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878935 = 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":"878936","type":"LOCAL"},{"code":"877598","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878936 = Hospital System Supply Identifier | 877598 = 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":"878940","type":"LOCAL"},{"code":"877602","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878940 = Hospital System Supply Identifier | 877602 = 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":"878939","type":"LOCAL"},{"code":"877601","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878939 = Hospital System Supply Identifier | 877601 = 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":"878941","type":"LOCAL"},{"code":"877603","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878941 = Hospital System Supply Identifier | 877603 = 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":"878937","type":"LOCAL"},{"code":"877599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878937 = Hospital System Supply Identifier | 877599 = 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":"878938","type":"LOCAL"},{"code":"877600","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878938 = Hospital System Supply Identifier | 877600 = 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":"878946","type":"LOCAL"},{"code":"877608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878946 = Hospital System Supply Identifier | 877608 = 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":"878945","type":"LOCAL"},{"code":"877607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878945 = 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":"878942","type":"LOCAL"},{"code":"877604","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878942 = 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":"878943","type":"LOCAL"},{"code":"877605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878943 = 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":"878944","type":"LOCAL"},{"code":"877606","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878944 = Hospital System Supply Identifier | 877606 = 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":"878947","type":"LOCAL"},{"code":"877609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878947 = Hospital System Supply Identifier | 877609 = 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":"878948","type":"LOCAL"},{"code":"877610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878948 = 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":"878949","type":"LOCAL"},{"code":"877611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878949 = Hospital System Supply Identifier | 877611 = 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":"878950","type":"LOCAL"},{"code":"877612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878950 = Hospital System Supply Identifier | 877612 = 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":"878951","type":"LOCAL"},{"code":"877613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878951 = Hospital System Supply Identifier | 877613 = 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":"878952","type":"LOCAL"},{"code":"877614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878952 = 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":"878953","type":"LOCAL"},{"code":"877615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878953 = 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":"878954","type":"LOCAL"},{"code":"877616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878954 = 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":"878955","type":"LOCAL"},{"code":"877617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878955 = Hospital System Supply Identifier | 877617 = 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":"878957","type":"LOCAL"},{"code":"877619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878957 = Hospital System Supply Identifier | 877619 = 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":"878956","type":"LOCAL"},{"code":"877618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878956 = Hospital System Supply Identifier | 877618 = 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":"878958","type":"LOCAL"},{"code":"877620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878958 = Hospital System Supply Identifier | 877620 = 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":"878959","type":"LOCAL"},{"code":"877621","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878959 = Hospital System Supply Identifier | 877621 = 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":"878960","type":"LOCAL"},{"code":"877622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":966.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 878960 = 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":"1176668","type":"LOCAL"},{"code":"1082486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176668 = 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":"1175758","type":"LOCAL"},{"code":"1082535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175758 = 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":"1175941","type":"LOCAL"},{"code":"1083660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1175941 = 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":"1176160","type":"LOCAL"},{"code":"1082540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176160 = 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":"1176281","type":"LOCAL"},{"code":"1083704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSM LOCATION | 1176281 = Hospital System Supply Identifier | 1083704 = 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":"1176266","type":"LOCAL"},{"code":"1082597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1518.75,"discounted_cash":1063.13,"setting":"both","b